title: The development of a user-led clinical service for newly diagnosed rheumatoid arthritis patients. An action research study.
abstract: OBJECTIVE
  To identify the clinical services required to meet the perceived needs of patients within the first 6-12 months following a diagnosis of rheumatoid arthritis in an orthopaedic NHS trust.
  
  
  METHODS
  An action research methodology was utilized. Twenty three newly diagnosed patients were asked to complete a questionnaire focusing on their needs at the time of diagnosis. The content included reactions to diagnosis, physical and psychological implications and clinical services that were required. A sub-sample of patients (n = 6) participated in an interview to explore these issues in more depth. A questionnaire was also distributed to 14 members of the multidisciplinary team (MDT) to ascertain their views on the purpose, content, and provision of a clinical service for newly diagnosed patients.
  
  
  RESULTS
  Eighteen patients agreed to take part (M:F, 9:9, age range 23-74 years, mean age 52.3 years, mean disease duration from diagnosis 16 weeks). Data from the questionnaires and interviews led to the following themes being identified: pre-diagnosis anxiety and fear, the impact of the diagnosis, physical and psychological implications of the diagnosis, and issues related to control perceptions. There was concordance between the MDT and the patients regarding impact of the disease and the need for information. Areas of the service that were identified independently by patients related to the importance of the period of time pre-diagnosis while awaiting the hospital appointment, and employment issues.
  
  
  CONCLUSIONS
  This study has identified the impact of RA in the early stages of pre- and post- diagnosis on physical, psychological and social functioning and has consequently informed service development.
authors.affiliation: Nuffield Orthopaedic Centre, Oxford. maureen.cox@noc.anglox.nhs.uk
authors.forename: Maureen
authors.initials: M
authors.lastname: Cox