Developing multidisciplinary guidelines for the management of early rheumatoid arthritis

OBJECTIVE

To develop an evidence based guideline, for the multidisciplinary management of early rheumatoid arthritis (RA).

METHODS

Recommendations were developed using both an evidence-based approach and expert opinion. The scientific committee, composed of key members of the rheumatology multidisciplinary team used a Delphi approach to evaluate topics and standard statements, which formed the basis for developing recommendations for management of RA in the first 2 years of disease. Evidence taken from literature was used to support these recommendations.

RESULTS

24 evidence based recommendations for the management of early RA, with a grade of recommendation from A to C, were developed. In addition an algorithm of care was designed to promote a clear multidisciplinary management pathway. A mechanism for audit was also identified.

CONCLUSION

Involvement of the multidisciplinary rheumatology team has enabled a holistic guideline to be developed for the management of patients presenting with early RA. This guideline is based around best practice that is supported by published literature. Whilst most statements in the guideline are based on strong evidence, others have been formulated by expert consensus in the absence of data and should serve as an opportunity to improve current practice through future research and audit. The development and implementation of such a guideline should improve the care of patients with early RA.

Evidence-based management for polymyalgia rheumatica for rheumatology practitioners, nurses and physiotherapists

Evidence-based practice is an increasingly popular term, used in a variety of clinical settings and situations. Practitioners are encouraged to use best evidence as part of clinical decision-making when caring for individual patients. This evidence, combined with practitioner expertise and knowledge, aims to inform practice, ensuring that accurate, effective and safe treatment options are utilized.

Benchmarking the nurse consultant role in rheumatology

This article demonstrates how the four core standards for the nurse consultant role have been developed and applied in the field of rheumatology. The authors suggest that the standards: expert practice, leadership and service redesign, research and education, are relevant for consultant nurses in all specialties. The standards can be used by other nurse consultants to benchmark their practice.

An evaluation of nurse-led rheumatology telephone clinics

AIMS AND OBJECTIVES

The aim of the study was to examine the impact on waiting times and patient satisfaction of nurse-led rheumatology telephone clinics.

METHODS

Patients awaiting outpatient review were contacted by the rheumatology clerk and offered a nurse-led rheumatology telephone appointment. Those who accepted were given a date and time for the appointment. A telephone consultation proforma was used to structure the call and to organize appropriate investigations/action. A questionnaire was mailed to the 68 patients reviewed during the first month of the telephone clinics to assess satisfaction. Status forms were also completed to record further action.

RESULTS

Of the 68 patients surveyed 73% completed and returned the questionnaire. Overall 72% were happy with the telephone consultation and would be happy to use the service again. Waiting times were reduced by two months as a total of 169 patients were reviewed during the April to August period.

CONCLUSION

Nurse-led telephone consultation, as part of chronic disease management, can be extremely beneficial for all rheumatology patients as a high level of satisfaction was achieved. In addition telephone consultations have helped to reduce the follow-up waiting times within the department by two months. This audit shows that telephone appointments conducted by an experienced nurse using an assessment proforma can be incorporated into routine follow-up care.