Impact of a rheumatology expert nurse on the wellbeing of patients attending a drug monitoring clinic

This paper reports a study to test the hypothesis that consultation with a clinical nurse specialist in a drug monitor clinic has a measurable impact on the well-being of patients with rheumatoid arthritis. A single blinded randomized controlled trial was carried out with 71 patients with rheumatoid arthritis who were starting new disease-modifying anti-rheumatic therapy at a district general hospital. Patients were randomized into two groups over a 3-year recruitment period. Intervention group patients were monitored by a rheumatology clinical nurse specialist using Pendelton's framework to assess patient needs alongside safety monitoring. Control group patients were seen by an outpatient staff nurse for safety monitoring only over a 1-year period. The primary outcome measures were the Arthritis Impact Measurement Scales and the Rheumatology Attitude Index. Data were also collected on the Disease Activity Score, number of consultations with healthcare professionals and changes in drug therapy. Data were collected at baseline, 3, 7 and 12 months between 1999 and 2002. The Intervention group had greater change scores than the Control group for the Arthritis Impact Scale, with statistical significance shown at 7 months (P = 0.03). At 12 months the Rheumatology Attitude Index had improved by a mean of 1.8 in the Intervention group and deteriorated by 0.3 in the Control group. Changes in the Disease Activity Score were greater in the Intervention group at all time points, with statistical significance at 12 months (P = 0.048). There was little difference in the number of consultations or changes in drug therapy between the two groups. Consultation with an expert rheumatology nurse in a drug monitor clinic may add value in terms of improving patients' perceived ability to cope with the arthritis.