By Dr Irwin Lim, Rheumatologist
Our previous posts on whether we should use patient-reported outcome measures, and in particular, the RAPID3, were well received.
If you missed them, here are the links:
At the start of April, after "negotiating" with all levels of our staff, including administration, allied health practitioners and doctors, we introduced the RAPID3 to BJC Health.
Across 3 different clinic sites. Involving the patients for the 6 rheumatologists, 7 physiotherapists and 3 exercise physiologists.
While the RAPID3 questionnaire was originally designed and validated for use in Rheumatoid Arthritis, it's architect Ted Pincus, had shown that it has utility in many other rheumatic diseases.
BJC Health had been searching for a simple measure that we could use for all. So, we chose to apply the RAPID3 to all our musculoskeletal patients, including osteoarthritis, all inflammatory arthritis, patients with a spinal problem or a knee injury, etc.
Logistics do matter:
- When patients arrive at the clinic, they are provided by our reception staff the 1-page RAPID3 to fill. This takes most less than a minute but some do struggle.
- To complicate matters, other craft groups such as dermatologists practice in our clinic. Our reception staff try and avoid giving these patients the form
- The patient or the reception staff hands the completed form to the treating health professional
- The health professional scores the answers. This should take less than 10 seconds
- The health professional enters the scores into our patient's electronic health record to enable us to track the results over time
- The patient's answers/responses may direct the health professional to enquire about specific problems
These are some of our observations after 1 month of using the RAPID3:
- We are consuming a lot of paper.
- Patients on the whole don't mind filling in the form and in fact, many do think it's helpful.
- Some struggle. The font has been too small for some. Some just don't seem to get a numeric scale.
- As expected, non-native English speakers struggle and many have refused.
- Reception staff struggled initially to remember to hand out the forms especially when the waiting room became busy but this is improving.
- Health professionals didn't enter the data into all patients' e-health records but this is improving.
- For patients who have presented more often eg twice a week to the physiotherapist for their acute knee problem, we needed to develop a system so that they weren't given the form twice in 1 week
- Our team is starting to see a benefit and really like that the patients have to sit and consider and then quantify their pain levels, and other measures of function. The overall score also give us a better sense of how much the condition/s is affecting the patient's ability to live life.
- We've picked up issues such as sleep disturbance and patients struggling with simple daily activities. Issues we may or may not have found out about in the general flow of a consultation.
We haven't captured every patient, every time they present to the clinic, but to date, 1297 RAPID3 questionnaires have been filled and recorded at BJC Health.
All in all, a good start. We're looking forward to being able to discuss and show a difference over time in how patients score.
If we feel we truly help our patients, and truly make a difference to their overall quality of life, we need to see improvements in this simple measurement.
After all, does it really matter if I feel chuffed that I've reduced the number of swollen joints I can detect in a patient, when that same patient still reports not being able to put on their socks or still can't return to playing tennis?Dr Irwin Lim is a rheumatologist and a director of BJC Health. You should follow him on twitter here. Arthritis requires an integrated approach. We call this, Connected Care. Contact us.