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Biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic
Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI), Hälsofrämjande processer. R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.ORCID-id: 0000-0002-4341-660X
School of Health Sciences, Jönköping University, Jönköping, Sweden.
Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
R&D Centre, Spenshult Hospital for Rheumatic Diseases, Halmstad.
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2014 (engelsk)Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 72, Suppl. 3, s. 139-140Artikkel i tidsskrift, Meeting abstract (Fagfellevurdert) Published
Abstract [en]

Background: Patients with chronic inflammatory arthritis (CIA) treated with biological therapy are usually monitored by rheumatologists. Research shows that a nurse-led rheumatology clinic is safe and effective in monitoring biological therapy (1) and contributed added value in patients within rheumatology care, because the encounter with the nurse led to a sense of security, familiarity and participation (2).

Objectives: To compare the cost of monitoring biological therapy in a nurse-led rheumatology clinic with those of a rheumatologist-led clinic in patients with low disease activity or in remission.

Methods: Cost comparison was based on data from a 12 month randomised controlled trial (1). A total of 107 patients were randomly assigned to either a rheumatologist-led clinic or to a nurse-led rheumatology clinic. The purpose of the intervention was to replace one of two annual monitoring visits at the rheumatologist-led clinic (control group; n=54) by a visit to a nurse-led rheumatology clinic (intervention group; n=53), based on person-centred care. Inclusion criteria were ongoing biological therapy and Disease Activity Score 28 (DAS28) ≤3.2. All patients met the rheumatologist at inclusion and after 12 months. All outpatient visits, team rehabilitation and all the telephone advice at the Rheumatology Clinic were registered for the patients who participated in the trial. Main outcome measures were direct costs related to rheumatology care during the 12 month follow-up period.

Results: After 12 months 97 patients completed the study. At the inclusion the patients had mean age of 55.4 years, disease duration of 16.7 years, and DAS28 was 2.1, with no significant differences between the two groups. There was no mean difference in changes in clinical outcome between the two groups (DAS28 -0.06; p=0.66). The total annual cost of team rehabilitation in rheumatology care, per patient monitored by the nurse-led rheumatology clinic was €580 compared with €1278 for monitoring by a rheumatologist-led clinic, translating in a €698 (55%) lower annual cost. The annual cost of just the outpatient rheumatology care provided by rheumatologist and rheumatology nurse, per patient was €457 for monitoring by the nurse-led rheumatology clinic compared with €598 for monitoring by a rheumatologist-led clinic, translating in a €141 (24%) lower annual cost.

Conclusions: Patients with stable CIA undergoing biological therapy can be monitored more cost effectively by a nurse-led rheumatology clinic compared to a rheumatologist-led clinic, with no difference in clinical outcome as measured by DAS28.

References

  1. Larsson et al. (2014). Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs, 70(1): 164-175.
  2. Larsson et al. (2012). Patients’ experiences of a nurse-led rheumatology clinic in Sweden – a qualitative study in patients undergoing biological therapy. Nurs Health Sci, 14(4): 501-507.
sted, utgiver, år, opplag, sider
London: BMJ Books, 2014. Vol. 72, Suppl. 3, s. 139-140
Emneord [en]
Biological therapy, cost comparison, nurse-led rheumatology clinic, randomised controlled trial
HSV kategori
Identifikatorer
URN: urn:nbn:se:hh:diva-27094DOI: 10.1136/annrheumdis-2014-eular.3805ISI: 000346919800424OAI: oai:DiVA.org:hh-27094DiVA, id: diva2:764928
Konferanse
EULAR (The European League Against Rheumatism) Annual European Congress of Rheumatology, Paris, France, 11-14 June, 2014
Tilgjengelig fra: 2014-11-20 Laget: 2014-11-20 Sist oppdatert: 2018-03-22bibliografisk kontrollert

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Larsson, IngridFridlund, BengtArvidsson, BarbroBergman, Stefan

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