title: Shared care or nursing consultations as an alternative to rheumatologist follow-up for rheumatoid arthritis outpatients with low disease activity--patient outcomes from a 2-year, randomised controlled trial.
abstract: OBJECTIVE
  To compare patient outcomes of three regimes of follow-up care for rheumatoid arthritis (RA) outpatients with low disease activity.
  
  
  METHODS
  RA outpatients (n=287) with Disease Activity Score (DAS28-CRP)<3.2 and Health Assessment Questionnaire<2.5 from two Danish rheumatology clinics were randomised to 2-year follow-up by either: (1) planned rheumatologist consultations, (2) shared care without planned consultations or (3) planned nursing consultations. The primary outcome was change in disease activity. DAS28-CRP, Health Assessment Questionnaire, visual analogue scale (VAS)-pain, fatigue, global health, confidence and satisfaction, quality-of-life by the Short Form 12 and self-efficacy measured by the RA Self-Efficacy questionnaire and the Arthritis Self-Efficacy Scale, were recorded annually and safety measures were recorded. x-Rays of hands and feet were taken at baseline and at 2-year follow-up. Mixed effect models were used to explore differences between the three groups over time.
  
  
  RESULTS
  At 2-year follow-up, the group allocated to nursing consultations had lower disease activity than the group that underwent rheumatologist consultations (DAS28-CRP -0.3, p=0.049). The nursing group increased their self-efficacy (Arthritis Self-Efficacy Scale 18.8, p=0.001), confidence (10.7, p=0.001) and satisfaction (10.8, p<0.001) compared with the rheumatologist group. The shared care group reported a transient lower satisfaction compared with the rheumatologist group after 1 year (-8.8, p=0.004). No statistically significant differences were seen in other outcome variables.
  
  
  CONCLUSIONS
  It is safe to implement shared care and nursing consultations as alternatives to rheumatologist consultations for RA outpatients with low disease activity without deterioration in disease control. Nursing consultations can enhance patients' self-efficacy, confidence and satisfaction.
authors: Institute for Regional Health Research, University of Southern Denmark, , Odense Denmark.
authors: Jette
authors: J
authors: Primdahl
authors: Jan
authors: J
authors: Sørensen
authors: Hans Christian
authors: HC
authors: Horn
authors: Randi
authors: R
authors: Petersen
authors: Kim
authors: K
authors: Hørslev-Petersen
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000451:nursing / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration*; D011594:Psychometrics; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Disease Activity; Health services research; Outcomes research; Rheumatoid Arthritis