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

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 implementatio...

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Autores principales: Child, Sue, Goodwin, Victoria A, Perry, Mark G, Gericke, Christian A, Byng, Richard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404042/
https://www.ncbi.nlm.nih.gov/pubmed/25884815
http://dx.doi.org/10.1186/s12913-015-0837-9
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author Child, Sue
Goodwin, Victoria A
Perry, Mark G
Gericke, Christian A
Byng, Richard
author_facet Child, Sue
Goodwin, Victoria A
Perry, Mark G
Gericke, Christian A
Byng, Richard
author_sort Child, Sue
collection PubMed
description 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’.
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spelling pubmed-44040422015-04-21 Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation Child, Sue Goodwin, Victoria A Perry, Mark G Gericke, Christian A Byng, Richard BMC Health Serv Res Research Article 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’. BioMed Central 2015-04-15 /pmc/articles/PMC4404042/ /pubmed/25884815 http://dx.doi.org/10.1186/s12913-015-0837-9 Text en © Child et al.; licensee BioMed Central. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Child, Sue
Goodwin, Victoria A
Perry, Mark G
Gericke, Christian A
Byng, Richard
Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title_full Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title_fullStr Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title_full_unstemmed Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title_short Implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
title_sort implementing a patient-initiated review system in rheumatoid arthritis: a qualitative evaluation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4404042/
https://www.ncbi.nlm.nih.gov/pubmed/25884815
http://dx.doi.org/10.1186/s12913-015-0837-9
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