Authors (including presenting author) :
Cheung MS, Lee KL
Affiliation :
Rheumatology Unit, Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Introduction :
Rheumatoid Arthritis (RA) is a chronic, systemic, inflammatory disorder associated with multiple joint pain and swelling. Early diagnosis and timely treatment initiation are recommended in the management of RA to minimize functional disability, reduce irreversible joint damage and enhance treatment response rate. However, long waiting time to rheumatology services usually causes a delay in diagnosis and is a significant barrier to provide quality care. Integrated Model of Specialist Outpatient Service through Rheumatology nurse clinic (IMSN) in RA was first implemented in 2018, in which the rheumatology triage nurse clinic is the first contact point of patients who suffer from joint pain, rheumatology nurse will perform appropriate physical assessment and arrange investigations for them.
Objectives :
To determine the effectiveness of pre-assessment nurse clinic in facilitating early diagnosis and prompt treatment commencement in RA patients.
Methodology :
This is a retrospective study. Patients newly referred to rheumatology unit with suspected RA were recruited to IMSN in 04/2021-03/2022 in a Pamela Youde Nethersole Eastern Hospital. Doctor consultation appointment will be advanced if patients were suspected to have rheumatic diseases and need prompt treatment after nurse assessment. The primary outcome was to evaluate the reduced waiting time of a new patient to rheumatology services. The secondary outcome was to review the time to diagnosis, time to treatment initiation and compare the disease activity score of those patients with newly diagnosed rheumatoid arthritis at 1 year follow up.
Result & Outcome :
A total of 100 patients were seen in IMSN with pre-assessment done. Average waiting time for the 1st nurse consultation was 5.9 weeks. 37 patients required an advancement of medical appointment. Waiting time of 1st doctor consultation reduced from a mean of 53.8 weeks to 12.5 weeks. 52 patients diagnosed with different spectrum of rheumatic diseases (32 RA & 20 Non-RA) and 62.5% of those newly diagnosed RA patients started treatment in their 1st doctors’ consultation. The disease activity score 28 (DAS 28) of them was significantly improved from a mean of 5.0 to 2.68. Over 80% of them achieved in disease remission or at low disease activity level at 1 year. Pre-assessment in rheumatology nurse clinic can effectively sort out suspected patients and reduce waiting time to specialist care, thus enhancing early diagnosis and treatment initiation. The service scope of integrated model is recommended to expand to other spectrum of rheumatic diseases, so as to enhance early access to specialist care and ensure better patient care.
