Rheumatologists on the road: a subspecialist's role in caring for the homebound

Area of Science:

• Rheumatology
• Geriatrics
• Home-based care

Background:

• The number of homebound individuals in the US is projected to increase significantly by 2030.
• There is a lack of specialized medical services for homebound populations with chronic conditions.
• This pilot program established a rheumatology consult service within a large academic home visit program.

Observation:

• Over 12 months, 57 home visits were conducted, including 31 new consults and 26 follow-ups.
• Referrals included management of connective tissue diseases, inflammatory arthritis, and procedures.
• The patient population was predominantly female (94%), Hispanic (45%), and elderly (80% aged 60-101).

Findings:

• Rheumatoid arthritis was diagnosed in 39% of new consults.
• Interventions included initiating disease-modifying antirheumatic drugs, performing procedures, and adjusting medication.
• Initial assessments using the Routine Assessment of Patient Index Data 3 (RAPID3) indicated high disease severity.

Implications:

• The study highlights the essential role of rheumatologists in community-based care for the growing homebound population.
• This service addresses an unmet need for specialized care in rheumatic diseases among homebound individuals.
• The program also offers valuable training opportunities for future community-based rheumatologists.