title: An evaluation of rheumatology practitioner outreach clinics: a qualitative study.
abstract: BACKGROUND
  Services for Rheumatoid Arthritis (RA) have evolved with the development of independently led outreach Rheumatology Practitioner (RP) clinics in Primary Care (PC). Their clinical and cost effectiveness, compared with Secondary Care (SC) services, has not been assessed. The RECIPROCATE study aims to evaluate their clinical and cost effectiveness. This part of the study aimed to explore health professionals' opinions of rheumatology outreach service.
  
  
  METHODS
  Using a qualitative design, semi-structured interviews were conducted with GPs, practice nurses, hospital doctors and RPs, from one hospital and seven PC practices in Norfolk, to elicit their opinions of the service. The interviews were analysed using thematic analysis.
  
  
  RESULTS
  All participants agreed the service was supportive and valuable providing high quality personalised care, disease management, social, and educational support. Advantages identified included convenience, continuity of care and proximity of services to home. RPs helped bridge the communication gap between PC and SC. Some participants suggested having a doctor alongside RPs. The service was considered to be cost effective for patients but there was uncertainty about cost effectiveness for service providers. Few disadvantages were identified the most recurring being the lack of other onsite services when needed. It was noted that more services could be provided by RPs such as prescribing and joint injections as well as playing a more active role in knowledge transfer to PC.
  
  
  CONCLUSIONS
  Professionals involved in the care of RA patients recognised the valuable role of the RP outreach clinics. This service can be further developed in rheumatology and the example can be replicated for other chronic conditions.
authors.affiliation: Norwich Medical School, University of East Anglia, NR4 7TJ, Norwich, Norfolk, UK. Asmaa.abdelhamid@uea.ac.uk
authors.forename: Asmaa S
authors.initials: AS
authors.lastname: Abdelhamid
authors.forename: Janice
authors.initials: J
authors.lastname: Mooney
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Walker
authors.forename: Garry
authors.initials: G
authors.lastname: Barton
authors.forename: Alex J
authors.initials: AJ
authors.lastname: MacGregor
authors.forename: David G I
authors.initials: DG
authors.lastname: Scott
authors.forename: Richard A
authors.initials: RA
authors.lastname: Watts
mesh_terms: D001291:Attitude of Health Personnel; D003159:Community-Institutional Relations; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010548:Personal Health Services; D011320:Primary Health Care; D015397:Program Evaluation; D036301:Qualitative Research; D012219:Rheumatology; D012944:Social Support; D000078329:Workforce