title: Patient-initiated appointments compared with standard outpatient care for rheumatoid arthritis: a randomised controlled trial.
abstract: OBJECTIVE
  To test the hypothesis that implementing a patient-initiated system of care could improve clinical outcome in rheumatoid arthritis (RA) using disease activity guided management.
  
  
  METHODS
  An 18-month controlled blinded end point two-centre study with 131 patients with RA randomised to intervention (n=64) or control (n=67). The intervention group participants were guaranteed appointments to a rheumatologist within 10 working days if they subjectively experienced a flare in disease activity. The control group participants were booked in advance according to guidelines. Independent assessments were performed in the two groups at 0, 3, 6, 12 and 18 months. Outcome measures included: Disease Activity Score 28 (DAS28), a Visual Analogue Scale (satisfaction with care, confidence in care), number of appointments with a rheumatologist.
  
  
  RESULTS
  DAS28 decreased. Median satisfaction and confidence in care were >90 mm on Visual Analog Scale. Median number of appointments was 3. There were no significant differences between the groups among these outcomes. Visits in the intervention group more often resulted in change of treatment than in the control group (p<0.001).
  
  
  CONCLUSIONS
  Patient-initiated care was neither better nor inferior to traditional care in terms of outcomes analysed. Patient-initiated appointments can safely be used in everyday outpatient care of RA to empower the patient, if disease activity guided management is applied. Further research should investigate if this intervention can target a subgroup of patients and hence also result in released resources.
authors.affiliation: Medical Management Centre, Department of Learning, Informatics, Management and Ethics , Karolinska Institute , Solna , Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fredriksson
authors.affiliation: Medical Management Centre, Department of Learning, Informatics, Management and Ethics , Karolinska Institute , Solna , Sweden.
authors.forename: David
authors.initials: D
authors.lastname: Ebbevi
authors.affiliation: Division of Nursing, Department of Neurobiology, Care Science and Society , Karolinska Institutet , Stockholm , Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Waldheim
authors.affiliation: Medical Management Centre, Department of Learning, Informatics, Management and Ethics , Karolinska Institute , Solna , Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Lindblad
authors.affiliation: Medical Management Centre, Department of Learning, Informatics, Management and Ethics , Karolinska Institute , Solna , Sweden.
authors.forename: Sofia
authors.initials: S
authors.lastname: Ernestam
keywords: Early Rheumatoid Arthritis; Health services research; Outcomes research; Rheumatoid Arthritis