A patient-initiated DMARD selfmonitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial

McBain, H. B., Shipley, M., Olaleye, A., Moore, S. & Newman, S. P. (2016). A patient-initiated DMARD selfmonitoring service for people with rheumatoid or psoriatic arthritis on methotrexate: a randomised controlled trial. Annals of Rheumatic Diseases, 75, pp. 1343-1349. doi: 10.1136/annrheumdis-2015-207768

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Abstract

Objective: To determine the effectiveness of a patient-initiated DMARD self-monitoring service for people with rheumatoid (RA) or psoriatic arthritis (PsA) on methotrexate.

Methods: A two-arm, single centre, randomised controlled trial assessing superiority in relation to healthcare utilisation, clinical and psychosocial outcomes. Participants were 100 adults with either RA or PsA on a stable dose of methotrexate, randomly assigned to usual care or the patient-initiated service. Intervention participants were trained how to understand and interpret their blood tests and use this information to initiate care from their clinical nurse specialist (CNS). The primary outcome was the number of outpatient visits to the CNS during the trial period. Differences between groups were analysed using Poisson regression models. Secondary outcomes were collected at baseline and after the 3rd and 6th blood tests. Disease activity was measured using either the DAS28 or PsARC, pain and fatigue using a visual numeric scale and the HAQII, HADS and SF12 were completed to assess disability, mood and quality of life, respectively. Differences between groups over time on secondary outcomes were analysed using multi-level models.

Results: The patient-initiated DMARD self-monitoring service was associated with 54.55% fewer visits to the CNS (p<0.0001), 6.80% fewer visits to the rheumatologist (p=0.23) and 38.80% fewer visits to the GP (p=0.07), compared with control participants. There was no association between trial arm and any of the clinical or psychosocial outcomes.

Conclusions: The results suggest that a patient-initiated service that incorporates patients self-monitoring DMARD therapy can lead to significant reductions in healthcare utilisation, whilst maintaining clinical and psychosocial well-being.

Item Type: Article
Additional Information: Copyright BMJ Publishing Group Ltd, 2016.
Subjects: R Medicine > RC Internal medicine
Divisions: School of Health Sciences
URI: http://openaccess.city.ac.uk/id/eprint/12307

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