A GERONTORHEUMATOLOGICAL OUTPATIENT SERVICE

Background: A new outpatient service was developed at the department of Rheumatology for elderly patients aged above 75 years, referred by the general practitioner, with serious locomotor problems threatening their independency.Objectives: The main purpose of the service was to keep the patients as independent as possible in their own environment.Methods: All patients were seen by a rheumatologist and by a nurse practitioner. The doctor assessed disease and impairment related factors, while the nurse gathered information about the functional consequences of the disorders on daily living. After this thorough investigation treatment options were discussed and advices were given to the referring physicians and other relevant care takers. If needed a physiotherapist, an occupational therapist or a social worker could be consulted. During one year this new service was evaluated.Results: Data from 100 patients were completed. The average age of the sample was 78 years and 85% were female. Most patients (55%) were diagnosed as having more than one rheumatological disorder. The most frequent diagnosis was osteoarthritis (60%) and 45% of the patients had a major inflammatory disease. Co-morbidity outside the locomotor system was found in 75% of the patients, but only in 5% of the cases this had a major impact on daily living. Eventually 69% of the patients could be referred back to the practitioner, 19% received permanent outpatient treatment by the rheumatologist and 12% of the patients were treated by a multidisciplinary team. This total of 31% of the patients who were attended by the rheumatologist or teammembers had on average lower levels of hand related dependence in activities of daily living. Both patients and referring physicians were asked to evaluate this service by completing a short questionnaire. Most patients (91%) were very positive and would recommend the service to other elderly people. The practitioners were equally positive, 89% thought it was a useful initiative and the treatment options were constructive and useful concerning pain relief, preservation of independence and mobility.Conclusion: Based on this evaluation it was concluded that this service offers a positive contribution for the care of this group of elderly patients and therefore it should be implemented in daily practice. However further research is needed to improve the selection of patients and the efficiency of the service.Citation: , volume , supplement , year 2002, page Session: Health services, economics and outcome research