Authors: (including presenting author): :
Cheung MS, HO CY, Lai WM, Lee KL, Jao HY, Tang CP, Lau J, Tsoi MH, Pang WC, Lee ZC, Lam YF, Ng ML
Affiliation: :
Rheumatology Unit, Department of Medicine, Pamela Youde Nethersole Eastern Hospital
Keyword 1: :
Pre-assessment nurse clinic
Keyword 2: :
prompt treatment initiation
Keyword 3: :
resource utilization
Keyword 4: :
rheumatology nurses
Introduction: :
The pre-assessment clinic is effective in reducing patient waiting time, facilitating early diagnosis and initiating prompt treatment for Rheumatoid arthritis (RA). In planning to extend the service scope of integrated model to other non-RA rheumatic diseases, the capabilities of rheumatology nurses to identify possible non-RA patients is important. Joint pain is a common presenting symptom with differential diagnoses spanning from systemic inflammatory diseases to non-inflammatory causes such as mechanical factors. Effective triage is crucial to prioritize timely care and avoid unnecessary specialist referrals.
Objectives: :
1) To determine the ability of the pre-assessment nurse clinic to identify both RA and non-RA patients and to initiate prompt treatment. 2) To evaluate the impact on healthcare resource utilization by streamlining the care pathway.
Methodology: :
A retrospective analysis was conducted using data collected from rheumatology nurse clinic between January and September 2024. Patients presenting with joint pain were recruited to nurse clinic for assessment. Those suspected of having rheumatic diseases were fast-tracked for early physician consultation within 2-8 weeks, while others will follow their routine appointment. The primary outcomes were to compare the diagnoses made by rheumatology nurses and rheumatologists, and to evaluate the time to treatment commencement. The secondary outcomes focus on reviewing patient outcomes after doctors’ consultation for those regarded as non-rheumatological conditions.
Result & Outcome: :
A total of 126 patients assessed in rheumatology nurse clinic were included in the analysis. Both rheumatology nurses and rheumatologists identified 65 patients with different spectrum of rheumatic diseases. Nurses suspected 35 patients with RA, 22 with non-RA rheumatic diseases and 8 with osteoarthritis (OA) while rheumatologists diagnosed 32 patients with RA, 25 with non-RA rheumatic diseases and 8 with OA after consultation. Excluding those with OA, 49 patients (85.9%) were able to initiate treatment, particularly disease modifying agents at their first physician consultation. Sixty-One patients did not receive any rheumatological diagnoses after nurse assessment, 14 of them defaulted their scheduled appointment, while 47 attended their first physician consultation between 8 months and 1.5 year later after. Among these 47 patients, 42 (87.5%) were discharged including 31 who were discharged just after a single specialist consultation. This significantly reduced unnecessary follow-up, duplicate investigations and clinic burden. Implementation of an integrated model in rheumatology setting has proven highly effective in ensuring efficient patient stratification. Expanding the service scope to include other rheumatic diseases has the potential to optimize resource allocation, minimize redundant healthcare encounters, and enhance overall service efficiency.
