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Arthritis next for shared care shift

An NHS study suggests rheumatoid arthritis could be next in the shift of care into the community, after finding GP management has significant benefits.

A shared-care model, with GPs taking on the bulk of responsibility for reviewing patients, was more cost-effective than rheumatologist care for stable patients.

Those under shared care had an average of 1.67 quality-adjusted life years over a three-year period, compared with 1.60 in the rheumatologist group.

Costs were slightly higher with shared care, but the researchers calculated it would be more cost-effective for 60 to 90 per cent of patients on stable treatment.

Study leader Professor Deborah Symmons, professor of rheumatology and musculo-skeletal epidemiology at the University of Manchester, said: 'The model of care appeared to work well – patients liked it and it was cheaper. That's not to say GPs could go completely solo.'

The shared-care model involved reviews every three or four months by GPs, with an annual review by a rheumatologist. But Professor Symmons conceded that increasing use of biologics had made care more complex since the study finished, in 2002.

The study, commissioned as an NHS Health Technology Assessment, compared symptom control by shared care with aggressive hospital treatment in 460 patients. It was published online by the Annals of the Rheumatic Diseases.

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