Multidisciplinary team care and outcomes in rheumatoid arthritis.
OBJECTIVE
Comprehensive rehabilitation, involving a team of health professionals from various disciplines, is widely used as an adjunct to pharmacological and surgical treatment in patients with rheumatoid arthritis (RA). Studies on the effectiveness and costs of such programs, as well as on developments regarding outcome measures and quality improvement in this particular field are reviewed.


RESULTS
Recent studies confirm that defined day patient multidisciplinary programs are equally effective as inpatient team care programs. It appears that similar effects, at lower costs, may be achieved by clinical nurse specialists coordinating multidisciplinary care in an outpatient setting. With respect to outcome measures on effectiveness of multidisciplinary team care, the use of function-specific and patient-oriented outcome measures is advocated. Moreover, the use of tools and procedures to enhance the role of the patient in the team care process and communication among health professionals may yield important leads for the improvement of the effectiveness and quality of multidisciplinary team care.


CONCLUSIONS
Comprehensive inpatient and day patient programs prove to be equally effective in patients with rheumatoid arthritis, while the employment of alternative forms of comprehensive care, such as care coordinated by a clinical nurse specialist, is promising. With respect to future research, challenges are related to the development and selection of adequate outcome measures, the enhancement of mutual communication, and a further definition and extension of the role of the patient in the team care process.
Vliet Vlieland
Thea P M
TP
Leiden University Medical Center, Department of Rheumatology, The Netherlands. t.p.m.vliet_vlieland@lumc.nl
D001172:Arthritis, Rheumatoid / Q000628:therapy*; D006801:Humans; D005791:Patient Care / Q000379:methods; D010348:Patient Care Team; D016896:Treatment Outcome