Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation

BMC Health Services Research

Richard Byng²  Christian A Gericke¹  Mark G Perry⁴  Victoria A Goodwin³  Sue Child² 

[1] The Wesley Research Institute, University of Queensland Schools of Medicine and Population Health and Queensland Brain Institute, Brisbane QLD 4066, Australia;PenCLAHRC, Plymouth University Schools of Medicine and Dentistry, ITTC Building, Tamar Science Park, Drake Circus, Plymouth PL4 8AA, Devon, UK;PenCLAHRC, University of Exeter Medical School, University of Exeter, Veysey Building, Salmon Pool Lane, Exeter EX2 4SG, UK;Department of Rheumatology, Plymouth Hospitals NHS Trust, Derriford Road, Plymouth PL6 8DH, Devon, UK

关键词: Direct access;    Follow-up;    Patient-initiated;    Rheumatoid arthritis;   

Others  :  1171106
DOI  :  10.1186/s12913-015-0837-9

 received in 2014-06-12, accepted in 2015-04-08,  发布年份 2015

【 摘 要 】

Background

The management of Rheumatoid Arthritis (RA), a chronic relapsing condition primarily affecting joints usually entails regular hospital reviews with a specialist. These reviews can occur when the patient is well. This study forms part of a service evaluation of a system wide implementation of a patient initiated review appointment system which we have called Direct Access (DA). The aim was to explore the experiences of patients and staff of a DA system in order to understand the process of the implementation and to identify potential improvements.

Methods

Twenty-three patients with RA that had completed one year of follow-up on the DA system and seven healthcare professionals (HCPs) involved in the implementation of the DA review system took part in semi-structured interviews. Thematic analysis was used to analyse the interview data and field notes.

Results

Four themes emerged in the data: (1) building patient confidence and empowerment, (2) right place right time, (3) safety, (4) the everyday challenges of managing change. These show that in order for implementation to be successful the patient needs to have confidence in using a new system of requesting a medical review, which, in turn, needs to be offered quickly and in a setting convenient to both patient and clinician. Embedded in the change process need to be systems for ensuring regular disease monitoring and general issues surrounding team working, communication and ownership of the change process also need to be considered from the outset.

Conclusion

The clinics offer increased patient autonomy and the opportunity for greater self-management of chronic disease. This fits with new models of care where the patient is considered to be ‘the expert’.

【 授权许可】

   
2015 Child et al.; licensee BioMed Central.

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