Nurse Practitioners Expected to See More Patients with Rheumatoid Arthritis

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Friday, November 17th, 2017
The number of individuals diagnosed with rheumatoid arthritis (RA) is growing. This chronic autoimmune disease is most likely to develop in older people and our aging populations, meaning that more patients will experience its inflammation, pain, joint stiffness, and progressive joint destruction.

Patients who have rheumatic disease are also highly likely to have comorbid chronic illness—nurse practitioners (NPs) need to remember that this is an autoimmune condition that affects multiple systems. More than one-third of patients who have RA also have cardiometabolic conditions, and more than two-thirds develop depression. Comorbid chronic conditions in the patient with autoimmune disease increase long-term disability, health care utilization, and out-of-pocket health care expenses.

Studies indicate that outcomes improve in patients who have rheumatoid arthritis when they:
·      have adequate self-management education and tools,
·      are able to voice their concerns about at-work productivity,
·      can access psychological interventions,
·      are heard by clinicians when they discuss fatigue.

The rheumatology community anticipates a shortage in specialists, meaning NPs will likely be called upon to fill a resource gap and help patients with RA.

Researchers from the University of Texas System Administration, Austin, Texas and Pfizer, Inc, in New York in collaboration with the American Association of Nurse Practitioners have published research that amounts to a needs assessment for NPs. They contacted NPs working in primary care settings, asking about their specific educational and professional needs regarding RA.

This large survey—2238 NPs responded—found that rheumatologists are unlikely to send adequate information to primary care providers. Most NPs did not receive consult notes, and 20% had no information at all.

The authors noted that many patients who have RA struggle to communicate efficiently with their rheumatologists. This is an area where community-based NPs can improve care and fulfill the patient expectations bulleted above if they are educated and prepared to do so. Participants in this study indicated strong interest in having tools to improve patient education and information transfer. They were particularly interested in engaging visuals.

This is a critical area, since remission is possible for most patients who have RA. Regardless, most patients do not reach their targets, and clinicians often fail to address languishing needs or step up care appropriately.

The authors concluded that training and education could help NPs identify RA patients early, leading to better intervention and less joint deterioration. This study appears in the Journal of the American Association of Nurse Practitioners.

Riley L, Harris C, McKay M, et al. The role of nurse practitioners in delivering rheumatology care and services: Results of a US survey. J Am Assoc Nurse Pract. 2017;29(11):673-681.

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