Background The successful management of rheumatic conditions involves an increasing complexity of care. As utilisation of protocol-driven consultations grows, there is an ever increasing pressure for clinicians to deliver more, but in less time. Even though drug therapies and strategies for care are improving, delivering care for rheumatic diseases in the holistic way that rheumatologists and their patients expect, is becoming paradoxically more difficult.
Objectives The aim of this study was to develop a Patient Concerns Inventory (PCI), where patients can identify areas that they wish to discuss with their clinican, ahead of a consultation in the Rheumatology clinic setting, to maximise the benefits of that interaction.
Methods This observational exploratory study occurred with two phases. Full ethics approval was granted for all parts of the study. Phase 1: the PCI was developed after a detailed systematic literature search, followed by multidisciplinary expert opinion comprising rheumatologists (and trainees), orthopaedic surgeons, nurses, occupational therapists and physiotherapists and three structured patient focus group discussions.The same panel of clinical specialists then arranged the individual items of the PCI into domains, using the Delphi technique. Phase 2: the PCI was piloted and evaluated in a general Rheumatology clinic with the same clinican consulting. Research nurses recorded items discussed during each consultation
Results The refined PCI comprised a total of 39 potential concerns, grouped into four domains: Physical and functional well-being, Treatment related concerns, Social care and well-being, Psychological, emotional and spiritual well-being. Fifty-four patients were assessed in the pre-PCI group and 51 in the post-PCI group. Median (IQR) duration of consultation was 8 (5-14) minutes without PCI and 15 (10-20) minutes with PCI. The pre-PCI group raised 335 concerns from 50 patients, median (IQR) of 5 (3-10) per patient, rising post-PCI to 521 concerns, median (IQR) of 9 (5-16) from 51 patients, p=0.002. Additional concerns predominantly arising from “Physical and functional well-being” and “Social care and wellbeing” domains. Most patients rated their experience with their doctor in the consultation as excellent or outstanding across all 11 questions in the questionnaire, both before and after the introduction of the PCI to the clinic setting.
Conclusions The PCI is a useful holistic needs assessment tool for Rheumatology clinics. Although its intial use may slightly prolong the consultation as the clinican gains familiarity of it, patients can raise a significantly higher number of concerns using this instrument, that do not occur at the expense of patient satisfaction. This may help in identifying areas of “unmet need”, which previously would have gone unnoticed.
Disclosure of Interest None declared
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