Successful interventions provided by rheumatology nurses
By Alice Goodman
Madrid, Spain—Two companion studies reported at the 2013 annual meeting of the European League Against Rheumatism (EULAR) show that nurse-led programs can improve the management of patients with rheumatoid arthritis (RA). Physician extender programs such as these can potentially be resource-saving and cost-saving.
The studies evaluated 2 programs led by nurses—a screening program for comorbidities in patients with RA, who are known to have a high number of concurrent health problems; and a self-assessment program for measuring disease activity according to the 28-joint Disease Activity Score (DAS28).
Screening Program and Self-Assessment Program
The first analysis showed that nurse-led screening resulted in more than twice as many necessary medical interventions per patient compared with the control group. The second analysis showed that teaching patients how to self-assess disease activity and bringing booklets with patients’ recorded DAS28 scores to clinic visits resulted in significantly more changes in disease-modifying antirheumatic drug (DMARD) therapy compared with controls.
Both studies were part of COMEDRA, a 6-month trial of 488 patients with stable RA who were attending 1 of 20 treatment centers in France. Patients were randomly assigned to a nurse-led screening program for comorbidity or to a nurse-led disease self-management program.
After 6 months, patients in one group switched to the other group. “We wanted all patients to be able to have the advantage of participating in these 2 nurse-led programs,” stated lead investigator Maxime Dougados, MD, Professor of Rheumatology, René Descartes University, and Chief, Department of Rheumatology, Hôpital Cochin, Paris, France.
In the comorbidity screening program, nurses screened patients for cardiovascular disease, infection, cancer, and osteoporosis, and then flagged patients’ records if further action was necessary (ie, a mammogram screening or a vaccination). Rheumatologists then had the choice of following up or not.
Screening led to twice as many medical interventions per patient ordered by the rheumatologist compared with in the control group (4.54 vs 2 interventions per patient, respectively; P <.001).
“Patients with RA have high rates of comorbidity that often go undetected. Screening by nurses is feasible, and our results show it is valuable. Nurse-led programs align with EULAR’s projects to promote nurse involvement in patient management,” explained Laure Gossec, MD, PhD, of the Service de Rhumatologie B, Hôpital Cochin, Paris, France.
“Treat-to-Target and EULAR recommendations suggest that nurses should be promoting self-management skills so that patients can regularly assess their disease activity. Nurses can teach patients these skills. Within 6 months, patients’ assessments led to significant changes in RA treatment,” said Susan M. Oliver, RN, MSc, Chairperson, Standing Committee of Health Professionals in Rheumatology, EULAR, and Nurse Consultant, Susan Oliver Associates, United Kingdom.
After 6 months, the nurse-led self- assessment program resulted in changes in DMARD therapy in 17.2% of the patients in the self-assessment group versus 10.2% in the control group (P = .012).
“We know the Treat-to-Target treatment regimen is based on the DAS score, and if patients understand how that works, it makes it easier for them to comply and become partners in treatment,” Ms Oliver said. n