GPs as successful at managing RA as 'overwhelmed' specialists
GP-led care of patients with rheumatoid arthritis frees up 'overwhelmed' rheumatologists without any detrimental impact on clinical outcome, a Government-funded trial has shown.
Abandoning traditional lifelong three- or six-monthly outpatient reviews for all RA patients also cut NHS costs by a third.
Up to 75 per cent of rheumatologists' workload is RA follow-up. 'Because the system is overwhelmed with routine reviews, it is difficult to accommodate GP requests for appointments to be expedited in times of need,' the researchers said.
They randomised 209 RA patients, with half receiving traditional routine outpatient follow-up. The other half had GP-led care with no routine hospital review. But the GP or patient could request an urgent specialist appointment within 10 days, according to a report on the Department of Health website.
Analysis after six years found the patients who had GP-led care had requested an average of eight specialist appointments. Those in the traditional care group had had an average of 13 routine outpatient reviews. The cost per patient per year fell from £342 under traditional care to £221.
There were no significant differences in complication rates, pain control, disability and in-patient stays between the two groups. But patients who had GP-led care were more satisfied and over 90 per cent of GPs also preferred the new system.
Trial leader Dr John Kirwan, consultant and reader in rheumatology at Bristol Royal Infirmary, said: 'This could change the way outpatients departments are run. It will have a major impact on waiting lists. The total number of visits was reduced substantially, but if patients are going through a bad patch and need to be seen frequently we can do that.'
Dr Louise Warburton, a GP in Shropshire, who has a special interest post in rheumatology at Cannock Hospital, Stafford, said a similar system was being piloted there in a bid to cut waiting lists. She added: 'It seems to work well.'
It's a waste of time seeing patients every six months. They need to be seen when they are ill.'