Satisfaction and Access to Clinical Care in a Rheumatology Clinic at a Large Urban Medical Center

Patient-reported experience with patient-reported outcome measures in adult patients seen in rheumatology clinics

OBJECTIVES

Patient-reported outcome measures (PROMs) are increasingly utilized in the evaluation of patients with rheumatic diseases. The aim of our study was to assess the patient experience with completing PROMs within rheumatology clinics, and identify patient characteristics associated with a more positive experience.

METHODS

We conducted a retrospective cross-sectional study of adult patients seen in rheumatology clinics between 1/1/2017 and 6/30/2017. Patients were included in the study if they completed at least one patient-reported experience question following completion of PROMs. Patient characteristics associated with more positive experiences were identified through multivariable proportional odds models.

RESULTS

12,597 adult patients (mean age 59 ± 15; 76% female; 84% white) completed PROMs, as well as questions on their experience completing PROMs. Patients agreed/strongly agreed that PROM questions were easy to understand (97%), useful (84%), helped their physician understand their health (78%), improved communication with their provider (78%) and improved control over their own care (70%). Predictors of better experience with PROMs included being younger, non-white, having lower income, and being a new patient. Worse self-reported health also predicted better experience with PROMs.

CONCLUSION

Our study found a positive patient experience with PROMs, which is a crucial component of their successful implementation and utilization. Findings from this study suggest PROMs may be particularly beneficial in new patients, minorities, those with lower income, and worse self-reported quality of life. Collecting PROMs could provide opportunities to improve patient-provider communication and enhance control over care for rheumatology patients who could most benefit.

Patients' perspective of a dedicated biologic clinic for inflammatory arthritis

PURPOSE

The purpose of this paper is to assess the patient's perspective on a dedicated clinic set up for patients diagnosed with an inflammatory arthritis who are being treated with a biologic. It proposes that dedicated clinics offer better overall care. The aim of this quality improvement survey is to evaluate the level of patient satisfaction with this clinic and identify any unmet needs.

DESIGN/METHODOLOGY/APPROACH

This study was based on a quality improvement survey, which was developed using Zineldin's five qualities model and assessed various aspects pertaining to service quality and improvement. A structured interview approach was used and 44 consecutive patients were recruited.

FINDINGS

This paper explores key aspects that influence patient satisfaction within a rheumatology outpatient setting such as education on arthritis and biologics and involvement in decision making. It provides insight on what patients value most and it also addresses organizational aspects that can have an impact on patient satisfaction. It suggests that service quality can be linked to the degree of patient satisfaction.

RESEARCH LIMITATIONS/IMPLICATIONS

Direct interviewing of patients could have introduced a source of bias whilst questions are being answered. On the other hand, it provided an opportunity to clarify instantly any doubts and therefore avoiding any inadvertent errors.

PRACTICAL IMPLICATIONS

This paper reinforces that specialized clinics enable the caring rheumatologist to provide better care for patients on biologics. Service providers should continue developing their services around the patient's needs and perspectives in order to continue improving the service.

SOCIAL IMPLICATIONS

Dedicated biologic clinics allow more judicious monitoring of patients who are taking these highly efficacious but costly medications.

ORIGINALITY/VALUE

This survey has reinforced that patients highly value dedicated clinics. These results strengthen the case that healthcare services should continue investing on specialized clinics.

Spanning generations-appointment reminder preferences among patients with rheumatic diseases

OBJECTIVE

This study aimed to determine the appointment reminder preferences of patients presenting to rheumatology clinics.

METHODS

An anonymous, self-directed survey was given to all patients attending our rheumatology clinic. Patients indicated age and reminder preferences in modality and timing. Patients were then divided into generational age groups as follows: generation Y (18-28 years), generation X (29-49 years), baby boomers (50-67 years), the silent generation (68-85 years), and the GI generation (≥86 years). Overall preferences, as well as preferences by generational age groups, were determined.

RESULTS

A total of 1000 survey forms were distributed among the patients; 949 were collected for a response rate of 94.9%. Of these 949 survey forms, we analyzed 637 (67.1%) and excluded 312 (32.9%).Of all patients, 99.5% viewed appointment reminders favorably. Most (72%, n = 461) of the patients surveyed indicated that they would prefer the timing of their reminder to be 4 days or less before their clinic appointment; 16% (n = 100) preferred timing between 5 and 7 days; another 12% (n = 77) of the patients indicated that they would prefer 8 days or longer in advance. Overall, the most preferred reminder modality was a telephone call (52%, n = 333). The least preferred modality overall was short message service (SMS)/text messaging (4%, n = 27). The most popular option selected in generation Y was text/SMS reminders, and patients belonging to that generational age group were more likely than any other group to favor text/SMS reminders (P < 0.0001).

CONCLUSIONS

Improved rheumatology clinic attendance would be beneficial given the need for disease assessment and medication monitoring. Most patients view appointment reminders favorably; however, no studies have assessed the modality and timing preferences of patients in a US rheumatology clinic. Modality, but not timing, preferences vary with generational age. The preference for newer modalities such as text/SMS reminder was predominately observed in the patients of generation Y, a population prone to clinic nonattendance.