Background DMARDs are beneficial for a number of rheumatic conditions. However, treatment effect may take a few weeks. On the other hand, patients may experience adverse effects (AEs) early on and they may not be able to follow complicated dosage titration regimen. In order to enhance treatment safety and empower self-management, rheumatic disease patients requiring initiation or change of DMARDs were recruited to a rheumatology nurse phone follow-up program.
Objectives (1) To evaluate the service outcomes of Rheumatology Nurse Phone follow-up Program and (2) explore the factors that may influence treatment adherence
Methods Upon initiation of DMARDs therapy at out-patient clinic or before hospital discharge, patients and/or their caregivers will be counseled for the new treatment plan and self-management knowledge by rheumatology nurse. A telephone follow-up by rheumatology nurse will be arranged within 4 weeks to monitor patients' condition. Treatment responses, AEs, drug concordance of patients and advice given in each phone consultation (PC) were recorded. Retrospective case review was performed.
Results There were 1230 episodes of PC performed by rheumatology nurse in 2015. 180 episodes of PC involved 76 patients (56 female) were randomly selected. The average number of PC was 2.4 times per case. The mean age of patient was 58 (24–85) years. Disease categories mainly involved rheumatoid arthritis (60.5%), systemic lupus erythematosus (7.9%), spondyloarthritis (5.3%) and gout (3.9%). The most common DMARDs prescribed were methotrexate (40.8%), hydroxychloroquine (27.6%), sulphasalazine (22.4%) and 39.5% of the study cases have received steroid courses. Among the 76 patients, 8 (10.5%) have taken wrong dosage and another 4 (5.3%) patients have not started therapy due to worries about potential AEs. Altogether 40 patients (52.6%) reported AEs after starting DMARDs. The most common AEs were rash, itchiness, dizziness, alopecia and oral ulcers. For non-adherence behaviour, 8 patients (10.5%) have self-stopped their medication and another 7 patients (9.2%) have self-adjusted the medication respectively. Eventually 90% of the cases were able to continue therapy with or without adjustment of regimes. Only 7 cases (9.2%) required interruption of current treatment or switching to other DMARDs due to AEs within the study period.
Conclusions Rheumatology nurse phone follow-up program provided a timely and convenient platform to increase patient understanding of disease and treatment, improve their self-efficacy and enhance safety and concordance with DMARDs treatment.
Disclosure of Interest None declared