Improving Rheumatology Practice Save

Abstract # 0830 - How to best book patient appointments in rheumatology clinic? Should these be scheduled every 3 or 4 months regardless of patient status? Should they be scheduled by patient need or disease activity?  This report looked at patient outcomes in 100 RA patients on DMARDS who were randomized to either Patients were randomised to either an "app" where patients self-initiated only one scheduled follow-up consultation after a year (app-group) or to usual care. The 12 mos. outcomes showed high satisfaction but less outpatient vists or telephone consultations with either the rheumatologist or the clinic nurse. Rheumatologists visits dropped from 3 per year (usual care) to 1.7 per year (scheduled app); similarly nurse visits dropped from 0.9 to 0.4 nurse visits per year. Disease activity outcomes were not different between groups. 

I haven't done either of these in my practice, but there is good data from others suggesting that "on demand" appointments scheduled by patients, leads to better patient satisfaction and opens up the rheumatologist clinic appointments for priority or urgent appointments or that backlog of people who are waiting to see you!

Abstract # 0815 - Dan Solomon and colleagues reported their effort to use virtual learning collaboratives (LC) (during the COVID pandemic) to better implement treat to target (TTT) in practice.    A LC was tested in 18 rheumatology practices (45 rheums), with the goal being improved implementation of TTT.  These were done by video-conferencing; with an initial 5-6 hour kickoff session and 6 monthly webinars.  Adherence with TTT was measured as a percentage of the TTT component processes: 1) measure RA disease activity, 2) determine a target disease activity, 3) make treatment changes if not at target, and 4) document shared decision-making.  Over 6 mos,TTT adherence improved from 50.7% at baseline to 83.7% at completion. Clinicians changed treatment in only 59% of visits where patients were not at target. Reason for TTT non-adherence included patient preference (33%), clinician preference (19%), clinician deemed symptoms were not from RA (25%), and the desire to observe the treatment effect for more time (19%).

Everyone says they measure and believe they are practicing TTT, but the data on routine practice suggests this is not the case - for many reasons.  One may well be that rheums haven't bought into TTT, may not believe the reasons behind TTT and, other than these 45 rheumatologists, they haven't been educated on the implementation of a TTT program. 

Dr. David Lieu brought these abstracts to my attention, see what he says in the accompanying video (thanks David!).