A multidisciplinary collaboration spells out best practice in care delivery for RA patients.
The Australian Rheumatology Association (ARA) officially launched its rheumatoid arthritis clinical care standard at Parliament House in Canberra last week.
Clinical care standards comprise a small number of quality statements based around measurable processes and outcomes, designed to drive and measure quality improvements in priority areas within a particular area of care.
Produced in collaboration with Arthritis Australia with input from general practice and allied health, the new clinical care standard for rheumatoid arthritis spells out best practice in care delivery for patients.
“Through collective effort and a shared vision for excellence, the RA clinical care standard is a testament to the ARA’s dedication to ensuring the best possible care for people of all ages with rheumatoid arthritis and fostering an environment of continuous improvement in rheumatology care,” said ARA president Dr Claire Barrett in a statement to members.
The first quality statements in the RA clinical care standard emphasise the importance of early diagnosis and early treatment. If there’s a strong suspicion of RA, the patient should be seen by a rheumatologist within four weeks and start treatment with DMARDs within four weeks of diagnosis.
The next standard relates to safe and effective use of DMARDs, which means pre-treatment screening for potential risks and contraindications and ongoing safety monitoring that takes into consideration people’s circumstances over time – for example, vaccination status, comorbidities, pregnancy, impending surgery and malignancy.
The standard recommends directing patients to educational resources and reputable support groups, noting it can help people with RA self-manage their condition.
Another of the quality statements sets out timelines for disease activity monitoring, where it’s assessed every one to three months until disease activity targets are met, then every six to 12 months thereafter.
In the event of flares, worsening symptoms or treatment-related adverse events between rheumatology appointments, patients need access to interim management advice and care – even if by phone, email or telehealth – until a definitive review can be conducted.
The standard recognises the importance of access to physical activity and pain management services that take into account an individual’s circumstances, preferences and needs.
It also recommends annual check-ins on emotional and psychological wellbeing and vaccination status, and assessment as and when needed for cardiovascular disease and fracture risk.
The standard also acknowledges a team-based approach to care, with access to many of these services involving other healthcare professionals.
The standard development process was led by rheumatology professor Catherine Hill with a working group comprising health care professionals including rheumatologists and other clinicians, allied health professionals and rheumatology nurses, as well as consumers.
Queensland GP Dr Jonathan Ong was a member of the RA clinical care standard working group, and GPs were invited to have their say on the draft quality statements.
“GPs have a unique perspective in primary care, as we’re often the first point of call in the attempt to differentiate an undifferentiated patient. We’re also often the only person following the patient along for the whole journey, managing the patient holistically in all aspects,” said Dr Ong.
Many a GP may question how achievable the clinical care standard is: they know it can take months to get a patient to see rheumatologist.
But for Dr Ong, it’s about what’s best practice.
“To me, this is best practice – early recognition, early diagnosis, early treatment, that’s best practice,” he said.
“The onus is on GPs and rheumatologists to make it work. If we’re not meeting best practice, we need to go back to the drawing board and figure out why we’re not meeting best practice and sort it out.
“As GPs, we need to do a good work up and make sure the referrals look good so it’s easy for the rheumatologist.
“If I’ve got someone with rheumatoid type symptoms and positive CCP, I will actually run around looking for a rheumatologist who’ll get them in, and the rheumatologist knows they really need to pick this up.”
There are several statements very much in the realm of GP care, such as immunisation, cardiovascular screening and fracture risk. They can also help refer to other health professionals for dietary advice, mental health and physical activity support, and pain management.
“Coordinating care is a big part of our role,” said Dr Ong.
“There’s also statements around monitoring disease activity and implementing a plan from the rheumatologist to deal with sudden joint swelling, flares, elevated inflammatory markers. I think having these standards of care will help us communicate and collaborate better as well.”
There are two summary versions of the standard: one for health professionals and one for consumers. Both are available on the ARA website. A full version of the standard will be submitted for publication next year.
Meanwhile, Arthritis Australia has launched a consumer care guide for juvenile idiopathic arthritis, with an consumer care guide for rheumatoid arthritis also due out in the coming weeks. Both were developed in collaboration with the ARA and co-designed by patients and carers.
The user-friendly care guides aim to help patients and their carers “navigate management of the diseases against best practice standards and minimise the impact of shortfalls in clinical care,” Arthritis Australia said in a statement.
