Shared care proves a win-win for methotrexate treatment

A shared care program for rheumatology patients on low dose methotrexate is promoting patient compliance and satisfaction while improving access to rheumatology outpatient clinics.

The program, launched in late 2017 in Queensland Health’s Metro North Hospital and Health Service, also responds to interest from local GPs regarding chronic disease management and shared care.

Dr Paul Kubler, Director of Rheumatology at the Royal Brisbane and Women’s Hospital, told the limbic that rheumatologist Dr Claire Barrett had first suggested the program.

A multidisciplinary team was set up that included rheumatologists, allied health practitioners, nurses and pharmacists. A pilot program ran at Barrett’s hospital in Redcliffe, Queensland with the support of a GP liaison officer .

“We asked selected GPs and patients who seemed to like the idea. It made things clearer for GPs about what to do in certain circumstances like how to handle minor abnormalities of liver function tests or when thinking about contraception,” said Dr Kubler.

An information sheet, provided to both patients and GPs after the first hospital visit, helped troubleshoot most of the common issues – from advice on alcohol consumption to information on side effects and drug interactions.

“Generally, most people with rheumatoid arthritis are seen about every six months and a lot can happen between visits. There’s a lot of preventative health care that can be done such as vaccinations and skin checks, which are the primary realm of GPs,” he said.

“Methotrexate is the most common drug we use and the one that causes most concern for patients and GPs. Rheumatologists see several patients per day but most GPs have only a handful of patients on methotrexate so this helps them with a clear and confident way to manage their patients,” he added

The program also aimed to free up time in the local rheumatology clinics.

“Every place has more demand than supply in outpatient clinics so we’re trying to work with GPs to do more shared care and GPs are keen to do more chronic disease management particularly rheumatoid arthritis and inflammatory arthritis,” said Dr Kubler.

The next phase of the program would be to improve patient interaction and engagement and possibly expand the program to include other common medications.

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