medwireNews: Patients with rheumatoid arthritis (RA) and low disease activity (LDA) have similar outcomes after 2 years of nurse-led follow-up to what they would have had if they saw a rheumatologist, Chinese researchers report.
Tommy Cheung (University of Hong Kong) and colleagues also found that more patients were satisfied with nurse-led versus rheumatologist-led care.
Writing in Arthritis Care & Research, the authors say that “this is the first study that confirmed the effectiveness and acceptance of nurse-led consultations among patients with stable RA in Hong Kong.”
They believe their findings “will encourage the formal implementation of nurse-led consultations” in China, where this approach has not “yet been widely adopted because its feasibility and quality has not been confirmed in the Chinese population.”
The single-center study randomly assigned individuals with LDA (DAS28-CRP ≤3.2 for at least 6 months) to attend nurse-led consultation (n=140) or rheumatologist follow-up (n=140) every 4 months for 2 years.
Rheumatology nurses performed the same assessments as rheumatologists and were trained to evaluate laboratory results and monitor drug adherence and tolerability, titrating doses where necessary. Patients in the nurse-led group routinely saw a rheumatologist once per year, but the rheumatology nurses consulted a senior rheumatologist if the patient developed any unexplained symptoms, laboratory abnormalities, or when initiating or switching DMARD treatment.
The researchers report that, at 2 years, 92.1% of patients in the nurse-led group and 91.4% of those in the rheumatologist group remained in LDA, with the 95% confidence intervals of the adjusted treatment difference within the predefined noninferiority margin of 15%.
This shows “that nurse-led consultation was not inferior to usual rheumatologist follow-up in terms of the primary endpoint,” Cheung et al remark.
The team found no significant differences in radiographic progression, adherence to medications, and patient reported outcomes between the two groups but note that DAS28-CRP remission rates at 2 years were significantly higher in the nurse-led versus rheumatologist groups (90.2 vs 80.0%) when only individuals who completed the study (n=132 and 135, respectively) were considered. There was no significant difference between the two groups (85.0 vs 77.1%) in the intention-to-treat analysis of this outcome, however.
At the end of the study, the proportion of participants who said they were satisfied with their overall care was significantly higher in the nurse-led group than in the rheumatologist group (91.1 vs 79.3%).
Cheung and team conclude that “accredited and structured rheumatology nursing training has [now] been disseminated through our network hospitals in Shanghai and Shenzhen to lay the foundation for this new care model in other regions of China.”
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