Is Patient-Centered Care Effective for Rheumatology?

When employing patient-centered care, rheumatologists and other healthcare providers aim to empower patients to actively participate in their care. This approach requires practitioners to communicate effectively with patients to address their needs.

Stanford Shoor, MD, clinical professor of medicine and rheumatology at Stanford University, currently leads a Stanford/Pfizer grant project investigating the use of patient-centered care as a practice model for patients with rheumatoid arthritis (RA) at Stanford’s Immunology/Rheumatology Clinic. He says patient-centered care involves a multiple-prong approach that begins with team-based care, which includes a patient-centered medical assistant (PCMA). The PCMA is trained in communication and RA and works with each rheumatologist and their patients. The PCMA attends the conclusion of each clinic visit, when the rheumatologist conveys a treatment plan. After the physician leaves the room, the PCMA reviews the plan with the patient to ensure they understand it.

The PCMA will then schedule a routine follow-up visit and arrange dates and times for secure email or phone calls—check-ins—at intervals prior to the patient’s next scheduled appointment. These follow-ups allow the team to continuously monitor the patient’s disease. During the check-ins, the PCMA conducts a simple survey that has a five-point scale designed to assess the patient’s disease status and determine any current needs, Dr. Shoor says. The PCMA reports the check-in results to the rheumatologist and assists them in meeting the patient’s needs.

Another aspect of patient-centered care is for healthcare providers to ascertain the patient’s priorities in an effort to provide quality care. The PCMA asks patients about their specific goal(s) for care. These goals are added to the Clinical Disease Activity Indicator (CDAI), in which the patient and physician rate disease activity, and the Routine Assessment of Patient Index Data (RAPID-3), in which the patient answers questions regarding daily function to determine the quality of their care.

Improving RA Care
Dr. Shoor says the patient-centered care approach can actually improve disease-specific outcomes. When patients are taught self-care skills, they may reduce arthritis pain by 20–30%. Dr. Shoor believes this level of pain reduction is nearly equivalent to that achieved by using non-steroidal anti-inflammatory medication.^1,2 Additionally, motivational interviewing strategies aid patients in adhering to arthritis-specific medications—which the practice’s self-management course also teaches and the physician and PCMA reinforce—and can improve disease-specific measures in RA.

Overall Satisfaction
Dr. Shoor says increased communication between patients and their rheumatologists via PCMAs has resulted in increased patient satisfaction. “In our pilot study, we found that having a single medical assistant linked to each patient and their rheumatologist provides a continuity of care that patients appreciate,” he says.