AB1352-HPR SHARED CARE – AN ALTERNATIVE WAY TO COPE WITH INCREASING SERVICE DEMAND
Authors: C. Yin Shuen, N. Woon Leung, L. Man Chi, L. Chi Kwai, C. Ching Man, S. P. Kong, L. Pik Fan, C. L. Leung
Journal: Annals of the Rheumatic Diseases (2020)

Background: Rheumatic diseases are immune-mediated disorders that affect the musculoskeletal system, soft tissues, blood vessels and connective tissue. Patients with rheumatic diseases need regular follow up for disease and drug toxicity monitoring. To cope with the increasing service demand, the Division of Rheumatology in the United Christian Hospital developed and expanded the shared care service. In the conventional practice, patients have to been seen by rheumatologist for every visit while the shared care service involved follow up by rheumatologist and rheumatology nurse in alternate sessions. Objectives: 1.To evaluate the effectiveness and safety of the shared cared service 2To evaluate the effectiveness of reduction in workload of rheumatology clinic Methods: This is a retrospective study involving the period from 1/1/2019 to 31/12/2019. Patients who attended the rheumatology nurse clinic for shared care were recruited and reviewed. All patients were selected and referred by rheumatologists. Criteria for shared care included regular follow up in rheumatology clinic and stable clinical condition. The length of follow up is adjusted according to patient condition. Services provided by rheumatology nurse (RhN) included disease education, drug and disease monitoring, drug advice and referral to other professionals and community service as indicated. During each visit, patient’s vital signs, disease activity and laboratory results were assessed according to standard protocol. RhN will make discharge record to ensure continuity of care. Results: Totally 489 episodes of attendance to nurse led clinic were recruited. Majority (97.3%) were arthritis patients. Others included lupus, vasculitis, Sjogren’s syndrome and miscellaneous conditions. The length of follow up ranged from 3 weeks to 24 weeks and most of the patients were follow up between 8 to 16 weeks. Shared care patients included those with stable disease for interval monitoring, and patients for drug initiation and titration. The ratio for disease monitoring and drug monitoring are 41.3% and 58.7% respectively. For the 489 episodes of attendance, 10 (2%) episodes needed rheumatologist intervention and 8 (1.6%) cases need advancement of follow up. Problems that required doctor interventions and advance follow up mainly are suboptimal disease control requiring medication adjustment or musculoskeletal ultrasound investigation. 178 (36.4%) episodes of nursing intervention were delivered, majority were medication advice (133, 27.2%). Reasons for nursing intervention included adverse drug reaction, abnormal investigation results, poor drug adherence and disease flare up. There were no emergency department attendance or admission related to rheumatic problems within one month of RhN follow up. Conclusion: The shared care service is smooth and can safely lengthen the follow-up intervals to reduce clinic visit burden in rheumatology clinic. RhN input also allowed prompt advice for steroid tapering and dose titration for disease specific medication for better disease control. Proper case selection and close collaboration between rheumatologist and rheumatology nurse is the key. Disclosure of Interests: None declared