Rheumatology Patient Education Programmes; identifying patients and evaluating outcomes
To identify Patients with Rheumatoid Arthritis (RA), lacking information on their condition, or who are in need of further support, who may benefit from attending a Multi-disciplinary (MDT) Patient Education Programme and to evaluate the usefulness of such.
NHS Trusts are encouraged to provide Patient Education Programmes in conjunction with the Service Development & Commissioning Directives, Arthritis & Musculoskeletal Conditions, Consultation Document (2006), Arthritis & Musculoskeletal Alliance (ARMA) Standards of Care for People with Inflammatory Arthritis (2004), British Society of Rheumatology (BSR) Guidelines: Rheumatoid Arthritis, the First Two Years (2006). Patients identified on a daily basis by Physiotherapist, Occupational Therapist, Nurse Specialist, and Consultant interaction and invited to attend a 6-week programme of Education delivered by the Rheumatology MDT (Nurse Specialist, Physiotherapist, Occupational Therapist, Dietician, Podiatrist, Welfare Rights). Six patients invited to attend at a time and are required to complete the ACREU Questionnaire (Linekar et al, 1997) over two phases, at the beginning and end of the programme (maximum score = 31, higher scores mean increased level of knowledge), and to complete an evaluation of the MDT (at the end of the programme) to give an indication as to whether their particular session was of no benefit, some benefit or of great benefit using a questionnaire
Group 1, 5 patients, Group 2, 3 patients (N=8).
ACREU Questionnaire issued over 2 phases in Group 2 only (N=3), differences in scores Phase I = 55, Phase II = 79.
Benefits of MDT patients either found MDT members of some or of great benefit.
Knowledge regarding Rheumatological condition and management of such appeared to increase over the 2 phases in Group 2.
Some examples of Patients comments:
- Now aware of how important it is to protect joints and will try to change the way I perform tasks
- Meetings were therapeutic
- Good to know there is such a strong Rheumatology Team to look after our welfare
- Enjoyed programme and would participate in any future groups
- Benefited from meeting other people with RA
- This has been a great help to me, keep up the good work
- I am not alone with the problems of RA
Data limited. Only 4 patients attended Group 2 and one did not return questionnaires.
ACREU Questionnaire designed for patients attending a Physiotherapist home education programme, therefore suitability for MDT teaching not established.
Group dynamics; strong characters in both groups may have influenced mindset of other patients.
Cochrane Systematic Review (2003) found patient education programmes have small, short term effects on disability with no evidence of long term benefits in adults with RA, however, shortage of studies exist evaluating the carryover effects of education.
Patients appear to find our Education Programmes beneficial; next programme commences January, 2008
To research, or devise a more suitable outcome measure for continued evaluation of programmes.
To compose database of all patients involved for posterity.