NRAS Patient in Focus Award 2007 - Small Unit Winner - Improving Communication between healthcare professionals, patients and their carers/relatives.

04/07/07 : Trish Cornell, Senior Rheumatology Practitioner, Poole Hospital NHS Trust

Background

Poole Hospital NHS Trust serves a population base of approximately 250,000 in East Dorset. The Rheumatology Unit is out patient based and comprises of 2 full time Consultants, a part-time Associate Specialist, 6 Rheumatology Practitioners (Nurse Practitioners and Allied Health Professionals wte 2.64), part time physiotherapist, podiatrist, occupational therapist, extended scope physiotherapy practitioners (back pain) and part time specialist registrar.

People with inflammatory arthritis (RA, PsA and AS) have their initial diagnosis made by the medical team and are then regularly reviewed by the Rheumatology Practitioners, who monitor both disease and drug therapies, initiate new treatments, refer to other health professionals, request investigations, counsel and ensure patients have full understanding of the treatment options [1] .

Improved communication between healthcare professionals, patients and their carers/relatives leads to better outcomes for the person with the underlying complaint [2] . We have developed targeted interventions to improve communication between ourselves, the people we care for and the health professionals within community and secondary care.

1. The Rheumatology Team

We have developed two initiatives to increase communication within the team:

a) Rheumatology Team meeting which is held monthly for 30 minutes, members includes secretarial, out patient nursing staff, medical staff and rheumatology practitioners and directorate manager – this ensures all team members are updated on recent developments within the Trust. The team is encouraged to bring thoughts and problems encountered to this meeting which are then discussed in a positive manner.

b) Rheumatology Practitioner meeting – a monthly meeting held over a lunchtime, the focus of this meeting is clinical developments, feedback from attendance at conferences, practitioner led initiatives, research and future plans, this also includes time for CPD. Members of this meeting are Rheumatology Practitioners, physiotherapist, occupational therapists, podiatrists and medical staff.

2. Patients

a) Patient Information leaflets – these have been devised to enhance and supplement the ARC leaflets. These are written by the practitioners, reviewed by the team and have formally passed the Trust Patient Information Group. The leaflets include information on our service, telephone advice line, exercises for people with inflammatory arthritis, driving with arthritis, smoking and arthritis, coping with pain and coping with a flare amongst some of the topics. These have been evaluated and presented at national meetings. [3]

b) Telephone advice line – this service is available to all patients who attend the rheumatology department. It is a manned system Monday to Friday 0900-1700, with an answer phone for all other times. It has proved to be invaluable for patients, carers, and health professionals. Audit of the service has been published and various components of the advice line have been utilised within the RCN guidelines for Telephone Advice Lines. [4]

c) Website – the team decided that with the advent of technology we should have a website; this was duly designed and has a wealth of information accessible for any member of the public or health professional. It has copies of all our information leaflets, links to patient groups and information about our service. www.poole.nhs.uk/our_services/rheumatology.asp

d) Away-day for patients, rheumatology team and community – we held a half day meeting to gather the views of all people involved locally in musculoskeletal care both providers and users. This was an interesting meeting and generated much discussion on how services could evolve over the next 10 years and a plan has been formulated.

e) Local ARMA group – Following the away day a local ARMA group has been formed, co-chaired by a patient and allied health professional. This group is actively seeking clarification on several issues surrounding local musculoskeletal care. Members include patients groups, patients, GP’s, Orthopaedic Consultants, Rheumatologists, Rheumatology Practitioners, physiotherapists, occupational therapists and podiatrists across East Dorset.

f) Newsletter – to ensure good communication with our patient population regarding future issues with service provision, local initiatives and government guidance documentation we have implemented a regular newsletter for patients and carers. This includes local news, fundraising and information on patient education afternoons, Expert Patient and patient groups.

g) Notice boards – we used a focus group of patients to gather ideas on how to improve the waiting room area. This was then implemented using more notice boards to highlight information on specific disease areas, local patient support groups and hints and tips board.

h) Patient education groups – we are lucky that our local PCT has supported the implementation of the Expert Patient Programme; prior to this the department ran its own programme based on the Kate Lorig model. This has been formally evaluated and published as a poster [5] . We now supplement the Expert Patient Programme with our own information afternoons for people with inflammatory arthritis and their carers/relatives. Topics have included:

* Evidence for complementary therapies

* New treatments

* Management of early RA

* Diet and smoking

* Exercise for life

* Coping with pain

* Coping with a flare

These have proved hugely popular with around 40-50 attendees at any one time. Evaluation has been undertaken and people have decided that they prefer to have these meetings 6 monthly and future topics have been noted.

3. Primary Care and Secondary Care

Poole Hospital Trust publishes a newsletter for the Primary Care Team entitled GP news. The Rheumatology Team regularly contributes articles to the newsletter about topical issues e.g. NSAID use in inflammatory arthritis and monitoring for methotrexate. We have also instigated a rolling programme of monthly lunchtime meetings in GP practices to encourage early referral for people with symptoms of inflammatory arthritis. We have also held study afternoons to inform GP’s about the newer treatments available and injection techniques. Primary care medical staff often attend our rheumatology clinics to gain further experience in the care of people with inflammatory arthritis. GP’s and practice nurses are encouraged to use the telephone advice line or email us with any queries they may have. All study days have been evaluated and changes to format made in accordance with suggestions.
Conclusion

Our targeted innovative interventions to improve communication within the Rheumatology Team, the people we care for and the community have been achievable using the available resources. Full patient involvement has been encouraged throughout the development of these initiatives utilising the use of focus groups and contact with local patient groups. Our initiatives have been formally evaluated and published within peer review journals and conferences.

References

[1] Thompson PW, Moran C, Aubrey-Fletcher S (1992) Rheumatology Monitoring Clinics Baillieres Clin Rheumatol 6 pp95-116

[2] Morrison P, Burnard P (1991) Caring and Communicating. Basingstoke MacMillan Press.

[3] Cornell P, Thompson P, Trehane A, Wright S, Taylor J, Benjamin S, Christopher J 2006 Cigarette smoking in RA patients - how many people want to give up and do we help them? Ann Rheum Dis 65 (supp II) 669

[4] Cornell P, Trehane A, Benjamin S, Thick G, Taylor J, Thompson PW, Hunt R (2000) Rheumatology telephone help-line, a survey of a link between patients and Rheumatology practitioners Br J Rheum 39 Abstract supp p170

[5] Cornell P, Bradley S, Thompson P (2003) Qualitative and quantative evaluation of an arthritis management programme (APEP) Ann Rheum Dis July Vol 62 suppl 1