Wigg AER1, Milanese S2, Ayres A1, Black R1,3, Proudman S1,3
1Rheumatology Unit, Royal Adelaide Hospital, CALHN, SA Health, 2International Centre for Allied Health Evidence, University of South Australia, 3Discipline of Medicine, University of Adelaide, Adelaide, South Australia
Background and aims: The Royal Adelaide Hospital (RAH) physiotherapist-led combined rheumatologist/physiotherapist clinic (CRPC) is a unique model of care where advanced scope physiotherapists work with consultant rheumatologists to provide a single visit, multidisciplinary assessment of patients. The clinic was established to reduce the non-inflammatory burden on rheumatologist-led clinics and to fast-track patients with inflammatory presentations. The aims of this study were to evaluate stakeholder satisfaction and clinical and service outcomes.
Methods: Patient and referring doctor surveys were administered and patient reported outcome measures collected. Wait times, discharge rates and costs were compared with a general rheumatology assessment clinic (GRAC)
Results: 102 patients were included (mean age 49 years). The majority were female, overweight and underactive and 94% had chronic pain (> 3 months).
The overall mean wait time was 3.3 months (vs 3 months for GRAC) and 15 days (vs 21 days) for category 1 patients. Following assessment, 24% (vs 51%) were classified as inflammatory, 29% (vs 10%) non-inflammatory and 47% (vs 39%) required further investigation. Forty-two percent (vs 10%) were discharged after initial assessment. Cost savings and benefits were observed for the CRPC and clinical improvements reported at 3 months.
Patient surveys were collected prior to (n=101), immediately post (n=98) and three months post (n=48) clinic. Immediately post clinic, over 90% of patients were satisfied with their experience with the clinic and the service provided by the clinicians. Numbers satisfied regarding confidence to cope with their condition almost tripled from pre- to post-clinic. At 3 months, improvements persisted but levels had reduced.
Referring doctors’ response rate was 42% (n=43). Over 90% were satisfied with all aspects of the clinic and all aspects of the physiotherapists involvement.
Conclusion:
The physiotherapist-led CRPC almost doubled capacity of the RAH rheumatology service for new patients. All patients were seen within clinically appropriate timeframes and almost half were discharged with conservative advice only. Stakeholder satisfaction was high. An advanced scope physiotherapist can assist in early identification of inflammatory patients requiring timely medical intervention, and discharge of a large cohort of patients not requiring specialist follow up, thereby reducing wait times and inappropriate patient burden on rheumatologist clinics.
Alison Wigg
Alison is a Senior Physiotherapist currently working at the Royal Adelaide Hospital in advanced scope roles in Rheumatology and Spinal Orthopaedics. She has a Bachelor of Applied Science and a Master of Applied Science in Physiotherapy and a Master of Business Administration. Prior to her current roles, she worked in private practice in Adelaide and Brisbane, as a lecturer and clinical educator on undergraduate and postgraduate programmes at the Universities of South Australia and Queensland, and as the Physiotherapy Head of Department, Royal Darwin Hospital. She has held a range research and project management positions in orthopaedics and rheumatology and was a recipient of a SA Health and UniSA Allied Health Research Collaboration Grant, which helped fund the current project.
