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Nurse-Led Care for Stable Patients with Rheumatoid Arthritis: Quality of Care in Routine Practice Compared to the
Elena Lopatina1, Deborah A Marshall2, Sharon A Le Clercq3
1Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Health Research Innovation Centre (HRIC), 3C60, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
Rheumatology and Therapy
|July 8, 2021
Summary
Nurse-led care (NLC) for rheumatoid arthritis (RA) is as effective as rheumatologist-led care (RLC), achieving similar remission rates. The NLC model also improved documentation of patient education and screenings for better chronic disease management.
Area of Science:
- Rheumatology
- Health Services Research
- Nursing Practice
Background:
- Rheumatoid arthritis (RA) management requires ongoing monitoring and patient support.
- Traditional rheumatologist-led care (RLC) may not always be the most efficient model for stable RA patients.
- Evaluating alternative care models is crucial for optimizing RA patient outcomes.
Purpose of the Study:
- To compare the quality of care between a nurse-led care (NLC) model and traditional rheumatologist-led care (RLC) for stable rheumatoid arthritis (RA) patients.
- To assess the non-inferiority of NLC compared to RLC in achieving disease remission or low disease activity.
- To evaluate process measures related to patient management within both care models.
Main Methods:
- A pragmatic non-inferiority study design was employed.
- Data were collected via chart review from 124 patients in each group (NLC and RLC).
- Primary outcome: percentage of patients in remission or low disease activity (DAS-28 ≤ 3.2) at 1-year follow-up. Process measures included comorbidity screening, education, and vaccination documentation.
Main Results:
- Nurse-led care (NLC) was non-inferior to rheumatologist-led care (RLC), with 97% of NLC patients and 92% of RLC patients achieving remission or low disease activity at 1 year.
- While baseline characteristics were largely similar, differences were noted in Health Assessment Questionnaire Disability Index scores and biologic agent use.
- The NLC group demonstrated superior documentation for comorbidity screening, patient education on flare management, and vaccination screening.
Conclusions:
- The nurse-led care (NLC) model is an effective and viable option for managing stable rheumatoid arthritis (RA) patients.
- NLC provides comparable disease control to RLC while potentially improving care process documentation.
- This study supports the integration of NLC models for efficient and effective chronic disease management in RA.
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