Authors (including presenting author) :
Fung SY
Affiliation :
Medicine & Geriatrics, Princess Margaret Hospital
Introduction :
Rheumatoid arthritis (RA) is a chronic inflammation condition that significantly impacts the joints and other organs, causing joint pain, stiffness, swelling and reduced flexibility. Early diagnosis and timely treatment are crucial to alleviate symptoms and prevent joint damage or disability. To address these needs, IMSN (Rheumatology) Clinic was established in Oct 2018 at PMH, providing rapid access and early assessment for RA patients, bundle clinic collaborating with medical officers for consultations and offering further follow-up care as necessary. RA is characterized by unpredictable disease flares that can profoundly impact patient’s QoL. Early identification of flares is essential for timely interventions. Current practices at the bundle clinic include drug and disease education following medical consultations, often requiring extensive discussion to explore treatment options that can prolong consultations and delay treatment initiation. To enhance outcomes and efficiency, a pre-consultation nursing assessment workflow was implemented to screen patient for active disease before medical consultations. This enables timely interventions and workups, thereby reducing the duration of discussions and expediting treatment initiation.
Objectives :
-Identify RA patients with active disease to facilitate timely intervention -Relieve demand on SOPC services by reducing the duration of medical consultations -Optimize the care delivery pathway for RA patients to enhance treatment initiation efficiency
Methodology :
A retrospective cohort study design was adopted, collecting and analyzing clinical outcomes from unselected RA patients attending IMSN (Rheumatology) bundle clinic from 1 Nov 2023 to 31 Oct 2024. A structured pre-consultation assessment workflow was implemented in bundle clinic including comprehensive evaluation on patient-reported outcomes, clinical symptoms, drug compliance, laboratory results, and psychological factors.
Result & Outcome :
Total 649 patients aged 19 to 94 attended bundle clinic during the 12-month period with 1182 attendance and 539 (83%) patients were female. Pre-consultation assessments indicated that 21.7% patients were experiencing active disease, 41.5% had moderate disease activity, and 36.8% were inactive. Among the 141 patients identified with active disease, 36 (25.5%) opted to initiate or switch biologic, while 79 (56%) keen to titrate up or switch disease-modifying anti-rheumatic drugs (DMARDs). Of the 269 patients classified with moderate disease activity, 2.6% commenced biologic therapy, and 27.1% initiated or titrated DMARDs. The remaining 70.3% preferred to maintain their current treatment regimen or explore alternatives, such as physiotherapy, traditional Chinese medicine, or intra-articular steroid injections. Comprehensive workups and detailed explanations on treatment options were provided to patients with moderate to active disease in bundle clinic, resulted in a reduction of consultation time from an average of 25 minutes to 15 minutes, representing a 40% decrease in time spent on explanations and ordering workup investigations. Notably, 81.4% patients initiated biologic therapy within 8 weeks. Reasons for delay exceeding 8 weeks included: the initiation of prophylactic treatment for latent tuberculosis, awaiting treatment funding and prolonged patient decision-making. At the time of analysis, 80% of patients exhibited significant improvement following the initiation of biologic therapy. Among those who chose to titrate or switch DMARDs, 38% reported significant improvement, 33% remained static, and 6.8% experienced worsening symptoms that required further follow-up interventions. Patients maintaining inactive were offered a drug refill option to alleviate workload in SOPC. Overall, pre-consultation nursing assessment demonstrates a commitment to improving both the quality of care and operational effectiveness in managing RA.
