Background Much effort has been made to improve the efficiency of health care system by delivering cost-effective, high-quality care.Nurse staffing's contribution to daily practice plays a significant role to reach this goal.
Objectives To elucidate the differences between ratios of nurse/physician consultation as well as physician efficiency index (PEI) of senior rheumatologists and junior physicians in rheumatology residency training regarding patients with Rheumatoid Arthritis (RA).In addition, to delineate the correlation of physician postgraduate experience and PEI.
Methods The mean intervals between standard consultation by a physician or nurse for all senior rheumatologists and junior physicians as well as nurse/physician visits ratio and PEI (= nurse/physician visits ratio * mean interval), regrading RA patients seen during Nov 2013–2015, were calculated. Multiple linear regression analysis was performed to delineate the relationship between physician postgraduate experience and PEI. To monitor treatment outcome, Disease Activity Score in 28 joints-C-reactive Protein (DAS28-CRP) and Health Assessment Questionnaire (HAQ) were consecutively measured three times: first at physician consultation, second at following nurse consultation and third either at a nurse or physician consultation.
Results 3699 visits, belonged to 672 RA patients (64.1% female, the mean of age 64.9±14.1 and DAS28 at baseline 4.5±1.2), were included. There was a significant difference between the nurse/physician visits ratios of senior rheumatologists and junior physicians (P=0.01). Additionally, the mean PEI of senior rheumatologists was significantly higher than of junior physicians (P=0.04) (Table 1). A positive correlation was found between physician postgraduate experience and PEI adjusted for DAS28 at baseline and number of patients for each physician (Regression coefficient (95% Confidence Interval): 5.427 (1.068–9.787), P=0.022). DAS28 and HAQ score were significantly decreased if physician visits were followed by nurse visits (P=0.004 for DAS28 and P=0.025 for HAQ) (Fig.1), indicating a good treatment outcome at nurse consultations.
Conclusions Junior physicians should be supervised to delegate responsibilities to nurse staffing. So, entire department operates more efficient, leading to prevent extra expenses (due to the differences in yearly salary of physicians and nurses). Quality of care should be monitored continuously by markers of disease activity and CRP.
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Disclosure of Interest None declared