Case study - National Rheumatoid Arthritis Society

The rheumatoid arthritis self-management programme

  • - Potential savings estimated at up to £54K per year per thirty patients enrolled

Working with England’s leading expert patient programme organisation (Expert Patients Programme CIC) the National Rheumatoid Arthritis Society has developed the rheumatoid arthritis self-management programme (RASMP), a six week self-management programme, which is evaluated over six months.

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The challenge

- To provide education and opportunities for people with rheumatoid arthritis to acquire self-management skills

- To empower people with rheumatoid arthritis to be more active, knowledgeable and engaged in decisions about their care

The solution

Delivered over a six week period using a structured teaching plan to engage participants, the course comprises tutor-led presentations followed by interactive  sessions with participants, handouts, group participation and personal experience discussion. The course is jointly led by two tutors, one a health professional, usually a nurse specialist, and the other a person living with rheumatoid arthritis. The aims of the programme are for patients to have:

- An improved understanding of rheumatoid arthritis and its treatments
- Increased confidence to self-manage their condition, and
- Responsibility for their own health and well being

Patients are referred by the rheumatology health professionals, and the programme is likely to be particularly beneficial to those who are less confident and less able to cope. The programme is quality assured and can be commissioned either by clinical commissioning groups or by service providers.

Service performance and outcomes

The programme was trialled working with the rheumatology team in Portsmouth. Programme participants were asked to compete a health education impact questionnaire at baseline, six weeks (the end of the course) and then again at six months. Aggregated results for the participants at the end of the six-week programme:

- 57% demonstrated substantial improvement in health directed behaviour
- 43% of respondents demonstrated substantial improvement in self-monitoring and insight
- 43% also showed a substantial improvement in constructive attitudes and approaches
- 57% demonstrated substantial improvement in skill and technique acquisition

(‘Substantial improvement’ is indicated where an average change of 0.5 is achieved in any single domain).

Patient focus and satisfaction

The NRAS programme is entirely centred on helping patients improve their disease self-management. The self-management course focuses on improving the following areas of patients’ self-management skills:

- Health-directed behaviour
- Positive and active engagement in life
- Emotional well-being
- Self-monitoring and insight
- Constructive attitudes and approaches
- Social integration and support
- Health service navigation

Financial outcomes

While the programme is in its infancy, similar initiatives have been evaluated and potential cost impacts estimated.

- A study of patients with a range of chronic conditions suggested that those in receipt of EPP show a reduction in costs in the range of £27 - £422 over a six month period
- An Expert Patients Programme report in 2010 estimated that a saving of approximately £1,800 per patient might be achieved

Based on these figures NRAS suggests that a saving of up to £54,000 may be possible if thirty patients completed the programme in one year.

Commissioning priorities

- The Rheumatoid Arthritis Self-Management Programme 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 actively engaged and encouraged to learn about their condition and how to manage it
- Medicines management – the programme actively promotes medication compliance

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.