The outcome of traditional or comprehensive outpatient care for rheumatoid arthritis (RA). Results of an open, non-randomized, 2-year prospective study.
This work presents results of a quasiexperimental prospective cohort study of the medium-term course of chronic rheumatoid arthritis (RA) under two different conditions of care. During 1984-1986 a total of 262 patients was recruited. All were new referrals to a university outpatient department. 121 came from the city of Hannover, FRG, and were assigned to comprehensive team care (cc) provided by two rheumatologists, a nurse, physician's assistant, occupational therapist, psychologist, and social worker; 141 came from outside Hannover and received care from a physician in training for internal medicine/rheumatology and a nurse, supervised by a senior registrar (TC). The patients in the first group were significantly older (57 vs 51 years), had more active disease (ESR 44 vs 31 mm/h), were more disabled (functional capacity 69 vs 78%), more often lived alone (27 vs 10%) and were more depressed compared with patients in the second group. There were no significant differences in gender (80% female), number of Rome criteria (5.2), and disease duration (6 years) between the two groups. 179 patients were followed for 2 years. There was no demonstrable difference between those who dropped out and those who continued in the study. Patients from both groups showed significant and clinically important improvements in ESR and number of swollen joints, whereas functional capacity and pain intensity did not change. Depression and patients' global self-rating improved only in the CC-group. Analyses adjusting for differences between the two groups were unable to show a different efficacy for either form of care.(ABSTRACT TRUNCATED AT 250 WORDS)
Raspe
H H
HH
Institute for Social Medicine, Medical University, Lübeck, FRG.
Deck
R
R
Mattussek
S
S
D000553:Ambulatory Care; D001172:Arthritis, Rheumatoid / Q000534:rehabilitation*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003191:Comprehensive Health Care; D004185:Disability Evaluation; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012047:Rehabilitation Centers