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Effectiveness of an integrated outpatient care programme compared with present-day standard care in early rheumatoid
Greet Esselens1, René Westhovens, Patrick Verschueren
1Department of Rheumatology, University Hospital Leuven, Belgium.
Objectives:
To investigate the effectiveness of an integrated care programme in daily practice compared with present-day standard care for ambulatory early rheumatoid arthritis patients.
Methods:
In this cross-sectional study, group A received programmed multidisciplinary outpatient care and group B standard rheumatologist-centred care. Demographics, disease duration, initial and actual treatment, disease activity (Disease Activity-28 Score), general health (Short Form-36 [SF-36]), functionality (Health Assessment Questionnaire [HAQ]), coping style (Utrecht's Coping List), illness perception (Dutch-Revised Illness Perception Questionnaire) and satisfaction about care were recorded.
Results:
Eight-nine patients were included in group A and 102 in group B. Demographics, rheumatoid factor, antibodies against cyclic citrullinated peptides and disease duration were comparable. More patients in group A received initial combination therapy (35% versus 3%). Actual treatment regimens were comparable. More patients were in remission (69% versus 39%) or had low disease activity (80% versus 60%), mean HAQ-scores were lower (0.52 versus 0.80), more patients had no functional impairment (38% versus 15%) and SF-36 scores were higher in group A. Coping style and illness perception were similar, except for illness coherence. Satisfaction differed only for aspects typically favouring a care programme. Participation in a care programme independently predicted remission and absence of disability in a regression model, including gender and initial treatment as other predictors.
Conclusion:
Disease activity was better controlled and functionality and general health better preserved in patients following an outpatient care programme. This was partly due to the easier implementation of an intensive initial treatment strategy but apparently also to other aspects of organized pharmacological and non-pharmacological care, to be defined in randomized, controlled studies.
