Identification of the pharmaceutical care issues of rheumatoid arthritis patients in secondary care

Objective: To explore the perceptions of multidisciplinary health care prof essionals (HCPs) and patients of the pharmaceutical care issues (PCIs) rela ting to rheumatoid arthritis (RA.). Design: Qualitative study using semi-structured one to one interviews and f ocus groups to explore patient perceptions. Interviews and focus groups wer e taped and transcribed verbatim, then described and coded for meaning to p roduce 'in-vivo' codes, which were then grouped to form themes. Nominal gro up methodology was used to generate and rank a list of HCP perceptions of t he key PCIs of RA patients. The PCIs were ranked according to clinical impo rtance and order of occurrence from admission as perceived by the HCP group . Setting: Rheumatology ward and outpatient clinic in a teaching hospital. Main Outcome Measures: Generation and ranking of PCIs, generation of themes from patient interviews. Results: Optimisation of pain control was identified by the nominal group a s being the primary aim for patients on admission and was also the most com monly described symptom by patients. Two PCIs not predicted by the HCPs' no minal group was the frequency of infections and the associated discharge an d patients described experiencing 'over-education' by HCPs, which could lea d to anxiety. Complementary medicine in conjunction with traditional therap y was raised as a significant health benefit by patients. Conclusion: Many patients' views mirrored the PCIs identified by HCPs, but some were not anticipated; the value of patient interviews to ensure approp riate service development was demonstrated. Several PCIs emerged for future incorporation by the multi-disciplinary team into standardised models of p harmaceutical care for use in secondary care and at the secondary/primary c are interface for improvement of seamless care. There is a need to target e ducational interventions and to identify those who will benefit from advice on complementary medicine. Further work is required to develop a tool to i dentify the educational needs of RA patients and targeting of the informati on provided. This will help ensure the delivery of pharmaceutical care is d esigned to match the needs of individual patients.