Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.
Clin Rheumatol. 2021 Sep;40(9):3599-3604. doi: 10.1007/s10067-021-05674-y. Epub 2021 Mar 6.
Scheduled routine visits in patients with rheumatoid arthritis (RA) may be in a stable period without active disease. Consequently, there is a demand for developing outpatient control procedures which cater to the needs of the individual patient.
This study aims to compare a patient-controlled outpatient follow-up system, Open Outpatient Clinic Programme (OOCP), with traditional scheduled routine follow-up (TSRF) regarding patient satisfaction and disease activity markers in RA patients.
In a 2-year randomized controlled trial, RA patients were allocated to OOCP or TSRF. OOCP patients had no scheduled appointments but were allowed acute appointments with their rheumatologist and had access to nurse-led consultations and a telephone helpline. Appointments for the TSRF group were scheduled according to routine procedures (clinical parameters: DAS-28, C-reactive protein, VAS pain, tender and swollen joint count, HAQ-DI and radiographs; psychological parameters: VAS patient satisfaction and EQ-5D).
Of 282 patients, 239 completed the study (OOCP/TSRF characteristics: age 61.4 ± 10.5/60.9 ± 12.2 years, females 77/74%, ACPA positive 66/65%). At years 1 and 2, OCCP had fewer visits (year 2: 2.6 ± 1.6 vs. 3.5 ± 2; p < 0.0005) but more phone calls (year 2: 0.7 ± 1.4 vs. 0.1 ± 0.3; p < 0.0005) compared to TSRF. OOCP was comparable to TSRF regarding clinical and psychological outcome measures, and no radiographic progression was observed.
OOCP was associated with significantly fewer visits but with more phone calls to the nurse and was comparable with TSGentofte University HospitalRF regarding clinical, psychological and radiographic outcomes. Thus, the organization of outpatient care according to OOCP may be applied to strengthen patient-centred care in patients with RA. ClinicalTrials.gov Identifier (July 20, 2020): NCT04476875 Key points • In a patient-controlled outpatient follow-up system, RA patients had significantly fewer visits compared to traditional follow-up. • The patient-controlled follow-up system was comparable with traditional follow-up regarding clinical, psychological and radiographic outcomes. • Organization of outpatient care according to a patient-controlled follow-up system may be applied to strengthen patient-centred care in patients with RA.
类风湿关节炎（RA）患者的常规门诊随访可能处于疾病稳定期，没有活动期。因此，需要开发针对个体患者需求的门诊控制程序。
本研究旨在比较患者自控门诊随访系统（Open Outpatient Clinic Programme，OOCP）与传统预约常规随访（Traditional Scheduled Routine Follow-up，TSRF）在 RA 患者中对患者满意度和疾病活动标志物的影响。
在一项为期 2 年的随机对照试验中，将 RA 患者分配至 OOCP 或 TSRF。OOCP 患者没有预约，但可以与风湿病专家预约急性就诊，并可接受护士主导的咨询和电话热线服务。TSRF 组的预约按照常规程序进行（临床参数：DAS-28、C 反应蛋白、VAS 疼痛、压痛和肿胀关节计数、HAQ-DI 和 X 光片；心理参数：VAS 患者满意度和 EQ-5D）。
在 282 例患者中，239 例完成了研究（OOCP/TSRF 特征：年龄 61.4±10.5/60.9±12.2 岁，女性 77/74%，抗环瓜氨酸肽抗体阳性 66/65%）。在第 1 年和第 2 年，OOCP 的就诊次数更少（第 2 年：2.6±1.6 次 vs. 3.5±2 次；p<0.0005），但电话咨询次数更多（第 2 年：0.7±1.4 次 vs. 0.1±0.3 次；p<0.0005）。与 TSRF 相比，OOCP 在临床和心理结局测量方面与 TSRF 相当，且未观察到放射学进展。
与 TSRF 相比，OOCP 就诊次数明显减少，但与护士的电话咨询次数增加，且在临床、心理和放射学结局方面与 TSRF 相当。因此，根据 OOCP 组织门诊护理可能有助于加强 RA 患者的以患者为中心的护理。临床试验.gov 标识符（2020 年 7 月 20 日）：NCT04476875 主要观点 • 在患者自控门诊随访系统中，RA 患者的就诊次数明显少于传统随访。 • 患者自控随访系统在临床、心理和放射学结局方面与传统随访相当。 • 根据患者自控随访系统组织门诊护理可能有助于加强 RA 患者的以患者为中心的护理。
