Imperial College Healthcare NHS Trust

Integrating patient care, education and clinical research

 


  • - Each patient taking part in clinical trials can potentially save the service more than £15.5K per year
  • - Patient education sessions score satisfaction ratings in excess of 96%

The rheumatology service at Imperial College Healthcare NHS Trust provides a streamlined patient pathway from diagnosis to treatment and long term follow up care, which seamlessly integrates clinical care with patient education and clinical research.


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The challenge

  • - Rationalise the services
  • - Improve and increase the quality of care for rheumatology patients
  • - Reduce departmental expenditure and increase operational income

The solution

  • - Scheduling routine follow-up and research follow-up visits in the same appointment slot, thus freeing up clinic lists to see new referrals
  • - Enrolling patients into interventional drug studies with biologic therapy and monitoring funded by the research sponsor for the duration of the trial. This led to significant cost savings in prescribing and pathology testing.

The service profile

The rheumatology service is delivered from a dedicated area at the hospital, also housing research, patient and healthcare professional education facilities and dedicated rheumatology secretarial support. The service incorporates:

  • - Early arthritis clinics
  • - Psoriatic arthritis and psoriasis clinics
  • - Spondyloarthropathy clinics
  • - Biologics clinics
  • - Hand osteoarthritis clinics
  • - Metabolic bone clinics
  • - Joint injection clinics
  • - Connective tissue disease

The service works with smoking cessation initiatives, including a dedicated stop smoking advisor.

NRAS meetings are held on site, and clinical nurse specialist delivered patient group education sessions allow current patients to share their experiences of treatment with those who are about to start anti-TNF therapy.

Research nursing staff attend patient education sessions to highlight opportunities for patients to participate in clinical research.

There is a multidisciplinary and holistic approach to treatment and care, and referrals can be made to podiatry, physiotherapy and dietetics.


Service performance and outcomes

The service:

  • - Avoids duplication of clinic visits
  • - Improves management of clinic capacity
  • - Saves on prescribing budget (drugs funded through research sponsor)
  • - Follows best practice guidelines
  • - Improves clinical teaching and a stimulating educational environment

Of a patient population of over 2,500:

  • - 40% have rheumatoid arthritis
  • - 6% have psoriatic arthritis
  • - 5% have ankolysing spondylitis
  • - 29% have connective tissue disease

Among the general clinic patient cohort approximately 30% of patients are in remission, 40% have low disease and 30% moderate. Among the biologics group 70% are in remission, 20% have low activity and 10% are moderate.

By April 2013, 24 patient education sessions had provided  education and counselling to 193 patients.

Patient focus and satisfaction

Patient education sessions provide an interface between clinical care and research. More than 70% of those who have attended the sessions have since participated in research.

  • - 78% of respondents rated their overall experience as “very good”, and rated the approachability and professionalism of staff as “very good”
  • - 98.2% of patients felt participation in a study was worthwhile and 96.4% of them would consider participating in another study
  • - 75% of patients who participated in the educational session participants completed a questionnaire. They graded the sessions on average from 4.81 to 5 across all questions (where 0 = poor and 5 = excellent)


Financial performance and outcomes

Streamlining services into monthly patient group education sessions saves £12,000 per year by reducing the number of appointments needed.

Each patient registered in a clinical investigation trial (therapy and monitoring costs paid by the research sponsor) saves up to £15,000 per year on biologic spend, £400 per year on three monthly follow-up visits, and £200 per year on blood tests during the trial. 


Commissioning priorities


The Imperial College Health care NHS Trust is an example of commissioning best practice in rheumatology and meets a number of the priorities for commissioners as outlined by the King’s Fund in 2013:
  • - Active support for self-management – patients are given advice and education as necessary
  • - Care co-ordination – enabling patients to access appropriate services quickly and easily. The service is aligned to smoking cessation initiatives as well as clinical research
  • - Medicines management – medication compliance is achieved through education at clinic appointments, and the patient education group

Sponsorship statement


This best practice case study project has been sponsored by UCB and supported by a medical education grant from Pfizer.
UCB and Pfizer have not had any influence over content: editorial control remained with the British Society of Rheumatology.

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We gratefully acknowledge the generous support of our sponsors, which enabled the case study project to take place.