Background Interprofessional group learning is a valuable educational tool in multidisciplinary settings as it helps improve clinical care and encourages professionals to learn with, from and about each other (CAIPE, 2006). Disease activity in rheumatoid arthritis is assessed using the DAS28 scoring system; and changes in treatment are influenced by the result of the DAS28 score. In our Rheumatology Department DAS28 assessment is carried out by many members of our multidisciplinary team including doctors, nurses and pharmacists. This necessitates checking of, and ensuring reproducibility of DAS28 scoring amongst our team, to enable appropriate management of patients.
Objectives We utilised educational theory to organise a group learning exercise to assess reproducibility of DAS-28 score and identify areas for improvement amongst multidisciplinary rheumatology healthcare professionals, based at a large general hospital in South West England.
Methods Four patients with rheumatoid arthritis were selected for the exercise based on availability. All members of the multidisciplinary team assessed the patients using the DAS28. 13 professionals participated in this activity: six rheumatology consultants (two academics), three rheumatology specialist registrars, three rheumatology specialist nurses and one rheumatology specialist pharmacist. Median scores and coefficient of variation expressed as a percentage (CV, calculated by standard deviation/mean x 100) were calculated for each patients overall DAS28 score and the constituent parts. CRP levels were fixed for each patient.
Conclusions Reproducibility of overall DAS28 scores and its constituent parts were generally poor according to the CV. No differences in reproducibility were seen when stratifying by professional group. All subcomponents of the DAS28 showed equally poor reproducibility. This may have important clinical implications for patient care, particularly when deciding on treatment escalation. This interprofessional learning exercise, deliberately bringing together all members of the rheumatology multidisciplinary team, has enhanced learning for all by identifying the following points: (1) no professional group is “better” than another when assessing DAS28; (2) standardisation of how we ask about the VAS subcomponent will be introduced immediately; (3) tender joints are to be classed as ones with any tenderness from reasonable palpation; and (4) clinical judgement should be used when assessing rheumatoid disease activity.
CAIPE (2006) UK Centre for the Advancement of Interprofessional Education (CAIPE) re-issues its statement on the definition and principles of interprofessional education. CAIPE Bulletin. 26:3
Disclosure of Interest None declared