Page 138 - Hospital Authority Convention 2017

Service Enhancement Presentations
HOSPITAL AUTHORITY CONVENTION 2017

F3.6 Clinical Safety and Quality Service I 14:30 Room 421

Evaluation of Rheumatology Nurse-led Clinic in Managing Patients with Rheumatoid Arthritis: A Retrospective
Study
2
1
1
Leung YME , Wong KYF , Kwok MLA , Tam LS 3
1 Department of Medicine and Therapeutics, Prince of Wales Hospital, The Hong Kong Polytechnic University, Department of
3
2
Medicine and Therapeutics, The Chinese University Of Hong Kong, Hong Kong
Introduction
Rheumatoid arthritis (RA) is a chronic, systemic, autoimmune disease characterised by inflammation of the synovial joints.
Management of RA patients is usually provided by rheumatologists only. Enhanced care provided by rheumatology nurses
between rheumatologist consultations may have beneficial effects in terms of symptom control. In Hong Kong, whether
rheumatology nurse care model can lead to favourable patient outcomes remain uncertain.
Objectives
To examine the clinical effectiveness of rheumatology nurse-led clinic in controlling disease activity as expressed in change
of Disease Activity Score in 28 joints (DAS28) in RA patients compared with usual care led by rheumatologists only.

Methodology
Tuesday, 16 May comprised of patients who attended rheumatology nurse clinic between doctor consultations in the clinic. Patient education
It was a retrospective study. Two historical groups of RA patients (30 patients in each group) were identified from attendance
records between 1 January 2015 and 20 July 2015 at the rheumatology outpatient clinics of a regional hospital. Group one
delivered by the rheumatology nurse included disease mechanism and self-assessment of disease activity. Medication
adherence was checked and importance of medication adherence was reinforced. RA treatment could also be intensified
if needed. Group two comprised of patients managed by rheumatologists only. Primary outcomes were changes in disease
activity (DAS28) at follow-up visit after the doctor clinic and nurse clinic.
Results
The mean follow-up duration for the study cohort was 20 weeks (median: 22.5 weeks). Patient global assessment and DAS 28
were similar for both groups at baseline. At follow-up, patient global assessment and in group one decreased from mean ±
SD: 42 ± 24.7 at baseline to 28.7 ± 24.6 at follow-up, which was approaching the minimal clinically important improvement
(MCII= -15). With regards to DAS28, there was an 8.2% decrease (absolute change: -0.38 ± 1.14) in DAS28 in group one,
suggesting a trend of improvement (p=0.081). The corresponding decrease in group two was 1.2% (absolute change: -0.05
± 1.47) and such decrease was not significant (p=0.863). Changes in DAS28 did not exceed minimal clinically important
improvement in both groups (MCII= -1.2).

This study demonstrates short-term benefits of a nurse-led programme on RA disease management. Future multi-centre
studies with a randomised controlled design and a larger sample will be required to confirm our findings.

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