Is Patient-Centered Care Effective for Rheumatology?

When employing patient-centered care, rheumatologists and other healthcare providers aim to empower patients to actively participate in their care. This approach requires practitioners to communicate effectively with patients to address their needs.

Stanford Shoor, MD, clinical professor of medicine and rheumatology at Stanford University, currently leads a Stanford/Pfizer grant project investigating the use of patient-centered care as a practice model for patients with rheumatoid arthritis (RA) at Stanford’s Immunology/Rheumatology Clinic. He says patient-centered care involves a multiple-prong approach that begins with team-based care, which includes a patient-centered medical assistant (PCMA). The PCMA is trained in communication and RA and works with each rheumatologist and their patients. The PCMA attends the conclusion of each clinic visit, when the rheumatologist conveys a treatment plan. After the physician leaves the room, the PCMA reviews the plan with the patient to ensure they understand it.

The PCMA will then schedule a routine follow-up visit and arrange dates and times for secure email or phone calls—check-ins—at intervals prior to the patient’s next scheduled appointment. These follow-ups allow the team to continuously monitor the patient’s disease. During the check-ins, the PCMA conducts a simple survey that has a five-point scale designed to assess the patient’s disease status and determine any current needs, Dr. Shoor says. The PCMA reports the check-in results to the rheumatologist and assists them in meeting the patient’s needs.

Another aspect of patient-centered care is for healthcare providers to ascertain the patient’s priorities in an effort to provide quality care. The PCMA asks patients about their specific goal(s) for care. These goals are added to the Clinical Disease Activity Indicator (CDAI), in which the patient and physician rate disease activity, and the Routine Assessment of Patient Index Data (RAPID-3), in which the patient answers questions regarding daily function to determine the quality of their care.

Improving RA Care
Dr. Shoor says the patient-centered care approach can actually improve disease-specific outcomes. When patients are taught self-care skills, they may reduce arthritis pain by 20–30%. Dr. Shoor believes this level of pain reduction is nearly equivalent to that achieved by using non-steroidal anti-inflammatory medication.^1,2 Additionally, motivational interviewing strategies aid patients in adhering to arthritis-specific medications—which the practice’s self-management course also teaches and the physician and PCMA reinforce—and can improve disease-specific measures in RA.

Overall Satisfaction
Dr. Shoor says increased communication between patients and their rheumatologists via PCMAs has resulted in increased patient satisfaction. “In our pilot study, we found that having a single medical assistant linked to each patient and their rheumatologist provides a continuity of care that patients appreciate,” he says.

Dr. Shoor measures success for each patient who has received patient-centered care by their satisfaction with their care, which is measured with CDAI and RAPID 3. He also evaluates whether patients have met their defined goal(s) for their care using a five-point scale that he has dubbed, “Have you met your goal?”

Although no studies exist that examine the satisfaction of rheumatologists or medical assistants regarding patient-centered care, Dr. Shoor’s practice developed a provider satisfaction survey, which they presented at the 2017 ACR/ARHP Annual Meeting. In their pilot study, they found that both rheumatologists and medical assistants had greater satisfaction scores after the study. “This [finding] is possibly a result of the increased support given to the rheumatologist by the medical assistant and increased patient contact,” he says.³

Another benefit of patient-centered care may be increased appointment accessibility for other rheumatology patients, because some RA patients may require fewer appointments. “Because the optimal frequency of routine follow-up visits for RA patients is unknown, scheduling had been based on habit or tradition,” Dr. Shoor says. Additionally, “without patient-centered care, disease activity was not monitored nor were patient needs accessed before the next regularly scheduled routine visit.

“We believe that continuous disease monitoring and proactive solicitation of patient needs in the interim between clinic visits will allow the disease activity of each patient’s RA to determine the optimal follow-up visit interval,” Dr. Shoor says. “We suspect that scheduled telephone and/or electronic check-ins will prolong the interval between routine clinic visits and, by doing so, will increase the availability of clinic appointments—another benefit.”

Karen Appold is a medical writer in Pennsylvania.

References

1. Lorig K, Holman H. Arthritis self-management studies: A 12-year review. Health Educ Q. 1993 Spring;20(1):17–28.
2. Warsi A, Wang PS, LaValley MP, et al. Self-management education programs in chronic disease: A systematic review and methodological critique of the literature. Arch Intern Med. 2004 Aug 9–23;164(15):1641–1649.
3. Sheth K, Valenzuela A, Shoor S, et al. Development and validation of a rheumatologist satisfaction with practice scale—“The Rheumatologist Satisfaction Scale” (RSS) [abstract]. Arthritis Rheumatol. 2017 Oct;69(suppl 10).