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OP0094-HPR Person-Centred Care (PCC) May Improve Health Care Consumer Skills More than Regular Care - an RCT in Patients with CIA Undergoing Biological Therapy
R&D Centre, Spenshult, Oskarström, Sweden.ORCID iD: 0000-0002-4341-660X
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.ORCID iD: 0000-0002-6294-538X
Halmstad University, School of Business, Engineering and Science, Biological and Environmental Systems (BLESS), Biomechanics and Biomedicine. R&D Centre, Spenshult, Oskarström, Sweden & Lund University, Lund, Sweden.ORCID iD: 0000-0002-8081-579X
2015 (English)In: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, no Suppl. 2, 104-104 p.Article in journal, Meeting abstract (Refereed) Published
Abstract [en]

Background: In person-centred care (PCC) a holistic approach, individualized care, empowerment and self-management are cornerstones. Patients are seen as persons with resources and are encouraged to take an active role in their own health care to become skilled or effective consumers of health care. Little is known of the impact of PCC vs. regular care on patients’ skills as health care consumers.

Objectives: To study the impact on effective consumers’ skills over 12 months in patients undergoing biological therapy and randomly assigned to either a nurse-led rheumatology clinic (NLC) based on PCC or to a rheumatologist-led clinic (RLC) as measured by the Effective Consumer Scale (EC17).

Methods: A 12 month RCT in 107 patients with chronic inflammatory arthritis.1 Inclusion criteria were ongoing biological therapy and a DAS28 ≤3.2. All patients met a rheumatologist at inclusion and after 12 months, while the 6 month follow-up was performed in the assigned group, either at a NLC (PCC) or at an RLC (regular care). Outcome measure was the EC17, developed and endorsed by the OMERACT to measure skills in decision-making, navigation and negotiation with health care professionals (0-100, worse to best). Minimally Important Difference (MID) of EC17 was calculated (≥ 0.5 SD of the mean baseline score)2 and patients categorized in three EC17 groups: improvement, no change or deterioration of consumer skills. Differences between intervention groups and EC17 groups were calculated with Chi2. Global health, pain and HAQ were measured for descriptive purposes.

Results: A total of 101 patients completed the EC17 at baseline (mean 84 SD 10) and after 12 months. Twelve patients had baseline scores higher than 95 and a MID in improvement could not be measured why they were excluded, leaving 89 patients in the trial (mean age 53 SD 12 years, mean disease duration 16 SD 11 years, 54% women, RLC n=44, NLC n=45). At baseline mean (SD) DAS28 was 2.05 (0.68), global health 22 (17), pain 23 (18) and HAQ 0.55 (0.51). A larger proportion of patients improved according to EC17 in the NLC compared with the RLC (42% vs. 23%), and a smaller proportion deteriorated (16% vs. 23%; table). The differences were not statistically significant (p=0.14), probably due to a small sample size.

Table. Proportion of patients who deteriorated (≥5 units), remained stable or improved (≥5 units) in EC17 over 12 months monitored at a NLC or an RLC, total n= 89.

EC17 deterioration

NLC 16%   (n=7)

RLC 23%    (n=10)

EC17 stable

NLC 42%   (n=19)

RCL 54%   (n=24)

EC17 improvement

NLC 42%   (n=19)

RLC 23%   (n=10)

Conclusions: A nurse-led rheumatology clinic based on person-centred care resulted in a greater proportion of patients who reported a long term improvement in skills as consumers of health services compared with patients monitored by a rheumatologist-led clinic. Larger studies are needed to confirm the result.

References: 1. Larsson I, et al. Randomized controlled trial of a nurse-led rheumatology clinic for monitoring biological therapy. J Adv Nurs 2014;70(1):164-75.

2. Strand V, et al. It's good to feel better but it's better to feel good and even better to feel good as soon as possible for as long as possible. Response criteria and the importance of change at OMERACT 10. J Rheumatol 2011;38(8):1720-7.

Place, publisher, year, edition, pages
London: BMJ Books, 2015. Vol. 74, no Suppl. 2, 104-104 p.
Keyword [en]
person-centred care, nurse-led rheumatology clinic, effective consumer
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-28578DOI: 10.1136/annrheumdis-2015-eular.1907OAI: oai:DiVA.org:hh-28578DiVA: diva2:821975
Conference
EULAR 2015, 16th Annual European Congress of Rheumatology – European League Against Rheumatism, Rome, Italy, 10-13 June, 2015
Available from: 2015-06-16 Created: 2015-06-16 Last updated: 2016-11-28Bibliographically approved

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