EULAR Annual Congress
EULAR Annual Congress
Perspective from Robert Landewé, MD, PhD
Perspective from John Isaacs, PhD, MBBS
Perspective from Iain B. McInnes, PhD, FRCP
Source/Disclosures
Source:

Hoeper K. Effect of nurse-led-care on patient outcomes in rheumatoid arthritis in Germany: A multicenter randomized controlled trial. Presented at: EULAR 2020 E-Congress; June 3-6, 2020 (virtual meeting).

Disclosures: Hoeper reports consulting for AbbVie and Celgene and being on the speakers bureau of AbbVie, Celgene, Chugai, Lilly, Novartis and Sandoz Hexal.
June 05, 2020
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Nurse-led care noninferior to standard of care for patients with RA

Perspective from Robert Landewé, MD, PhD
Perspective from John Isaacs, PhD, MBBS
Perspective from Iain B. McInnes, PhD, FRCP
Source/Disclosures
Source:

Hoeper K. Effect of nurse-led-care on patient outcomes in rheumatoid arthritis in Germany: A multicenter randomized controlled trial. Presented at: EULAR 2020 E-Congress; June 3-6, 2020 (virtual meeting).

Disclosures: Hoeper reports consulting for AbbVie and Celgene and being on the speakers bureau of AbbVie, Celgene, Chugai, Lilly, Novartis and Sandoz Hexal.
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Rheumatology care led by a nurse or other ‘rheumatological assistant’ was shown to be as effective as standard of care for patients with rheumatoid arthritis in Germany, which is dealing with a critical shortage of rheumatologists, according to data presented at the EULAR 2020 E-Congress.

“The reality in Germany is that there are not enough rheumatologists to cover all the bases,” Kirsten Hoeper, PhD, MSc, of the department of rheumatology and immunology at Hannover Medical School, in Germany, said in her presentation. “The need doubles the amount, and the impact is huge.”

Photo of a nursing student with a cell phone
Rheumatology care led by rheumatological assistants “did not undermine” standard of care for patients with rheumatoid arthritis in Germany, which is dealing with a critical shortage of rheumatologists, according to data presented at the EULAR 2020 E-Congress.

The most obvious effect of a shortage of rheumatologists is prolonged patient wait times for a consultation. “There is a window of opportunity of 3 months to start treatment, but waiting times are often 9 or 12 months,” Hoeper said.

The impact of such a wait on treatment outcomes is direct. “If you want to start therapy, you want to see patients often to see if the treatment works,” Hoeper said. “But they are not seeing patients because there are not enough rheumatologists.”

Beyond disease parameters, patient satisfaction is another consideration, according to Hoeper. “Patients have to cope, they have to inject a new therapy, they have a lot of questions” when they start treatment, she said.

It was with this in mind that the group noted results of studies from across northern Europe showing that nurse-led rheumatology care has produced measurable improvements in rheumatic disease activity. “The solution is to include nurses with the care team,” Hoeper said. “But you have to make sure it is safe and effective like you would for any other treatment or intervention.”

Nurse practitioners currently fill no official role in routine rheumatology care in Germany, according to Hoeper. But as evidence supporting the use of nurse practitioners in rheumatology grows, and with legal precedent allowing for nurses to take a larger role in rheumatology care in the country, the group conducted the Effectiveness of RFA-led Clinics, or ERFASS, trial.

The prospective, multicenter, randomized controlled data set included 236 patients with RA from eight centers around the country. Accrual occurred between Jan. 1 and Aug. 31, 2018, with follow-up through December 2018.

Study protocols called for treat-to-target visits 4 to 6 weeks after initial consultation to be conducted by a nurse practitioner, along with two of the possible four annual visits. Contact with a rheumatologist was based on the patient’s particular clinical needs. “Half of the patients were treated by a rheumatologist using the standard of care,” Hoeper said. “The other half were seen by a rheumatology nurse.”

Results showed the noninferiority of nurse-led care compared with physician-led care, according to Hoeper. It is the first study in Germany to demonstrate such a result. “We saw that it did not undermine the current standard of care,” she said.

Moreover, patients in the nurse-led intervention group rated the quality of care, trust in the practitioner and treatment satisfaction comparably with the rates given to doctors. “Patients really liked it,” Hoeper said. “They did not feel abandoned or treated poorly by the nurses.”

There was an additional benefit to the program, as well: “This intervention opened things up for rheumatologists to devote time to complex patients and address questions they might have,” Hoeper said.

“Overall, this is an exciting new way to improve the care for our patients in Germany,” Hoeper concluded.