Background A Nurse Led Treatment Escalation Clinic for newly diagnosed adult Rheumatoid Arthritis patients was established in late 2010 in direct response to clinical need and to deliver Treat to Target’ (T2T) recommendations of responsive early effective treatment intervention. A Service Evaluation was undertaken in 2012 of the clinic between 2011-2012.
Objectives Does early intervention with treatment escalation induce clinical remission/ acceptable low disease activity, utilising patient clinical outcome measure DAS28. Is patients rheumatology experience improved by attendance of this clinic?
Methods The Evaluation was divided into 2 parts:
1. A retrospective analysis of routinely collected clinical data including DAS28, treatment escalation intervention at baseline 6 weeks,3,6,12 months and referrals for biologic consideration.
2. An anonymous Patient Experience Questionnaire was distributed.
Results The data retrieved from 82 patients showed a significant overall improvement in DAS28. Median disease activity scores revealed a reduction in DAS28 from 5.74 at baseline and prior to treatment, to 2.55 at 6months, so achieving clinical remission of<2.6. This outcome is sustained and further improved at 12 months with DAS28 average of 2.3. 2 patients at 6 months and 3 patients at 12 months were referred timely for biologic treatment.
Optimum clinical intervention would appear to be Methotrexate 20mgs weekly, with Hydroxychloroquine 200mgs b.d the drug most used in combination.
Cost effectiveness is demonstrated through the early aggressive intervention with first line DMARDs escalated efficiently to control disease activity and achieve clinical remission.
Patient Experience Feedback from 50 patients revealed 98% felt the clinic was an integral part of their rheumatology care, with 92% expressing that they experienced symptomatic improvement through treatment escalation.
Conclusions This model of patient focussed RA care, developed in response to ‘Treat to Target’ recommendations and clinical need, delivered by the Rheumatology Specialist Nurse through responsive, rapid treatment escalation demonstrates significantly improved clinical and economic outcomes, with excellent patient experience feedback and is transferable to any chronic disease management in both primary and secondary care.
References Smolen, J.S., Aletha, D., Bijlsma, J.W.J. et al. (2010a) T2T Expert Committee. ‘Treating rheumatoid arthritis to target: recommendations of an international task force. Annals of the Rheumatic Diseases, 69 (4), pp.631-37
Disclosure of Interest None Declared