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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Musculoskeletal Disorders 1/2015

A nurse-led rheumatology clinic versus rheumatologist-led clinic in monitoring of patients with chronic inflammatory arthritis undergoing biological therapy: a cost comparison study in a randomised controlled trial

Zeitschrift:
BMC Musculoskeletal Disorders > Ausgabe 1/2015
Autoren:
Ingrid Larsson, Bengt Fridlund, Barbro Arvidsson, Annika Teleman, Petra Svedberg, Stefan Bergman
Wichtige Hinweise

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

IL initiated the study, contributed to the study design, performed the data collections, data analysis, drafted the manuscript, has approved the last final submitted version and obtained funding. BF contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version and obtained funding. BA and PS contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version. AT initiated the study, contributed to the study design, provided critical revisions of the paper in terms of important intellectual content, approved the final submitted version. SB contributed to the study design, performed the data analysis, drafted the manuscript and has approved the last final submitted version. All authors read and approved the final manuscript.

Abstract

Background

Recommendations for rheumatology nursing management of chronic inflammatory arthritis (CIA) from European League Against Rheumatism (EULAR) states that nurses should take part in the monitoring patients’ disease and therapy in order to achieve cost savings. The aim of the study was to compare the costs of rheumatology care between a nurse-led rheumatology clinic (NLC), based on person-centred care (PCC), versus a rheumatologist-led clinic (RLC), in monitoring of patients with CIA undergoing biological therapy.

Methods

Patients with CIA undergoing biological therapy (n = 107) and a Disease Activity Score of 28 ≤ 3.2 were randomised to follow-up by either NLC or RLC. All patients met the rheumatologist at inclusion and after 12 months. In the intervention one of two annual monitoring visits in an RLC was replaced by a visit to an NLC. The primary outcome was total annual cost of rheumatology care.

Results

A total of 97 patients completed the RCT at the 12 month follow-up. Replacing one of the two annual rheumatologist monitoring visits by a nurse-led monitoring visit, resulted in no additional contacts to the rheumatology clinic, but rather a decrease in the use of resources and a reduction of costs. The total annual rheumatology care costs including fixed monitoring, variable monitoring, rehabilitation, specialist consultations, radiography, and pharmacological therapy, generated €14107.7 per patient in the NLC compared with €16274.9 in the RCL (p = 0.004), giving a €2167.2 (13 %) lower annual cost for the NLC.

Conclusions

Patients with CIA and low disease activity or in remission undergoing biological therapy can be monitored with a reduced resource use and at a lower annual cost by an NLC, based on PCC with no difference in clinical outcomes. This could free resources for more intensive monitoring of patients early in the disease or patients with high disease activity.

Trial registration

The trial is registered as a clinical trial at the ClinicalTrials.gov (NCT01071447). Registration date: October 8, 2009.
Literatur
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