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Its all about the patient

Published on 01 January 2010
Source: Arthritis Today

Professor David Scott

King’s College Hospital has a reputation for patient-based research that results in direct, practical outcomes. Jane Tadman reports on an Arthritis Research UK-funded study that has influenced current rheumatoid arthritis guidelines.

Rheumatoid arthritis (RA) patients being treated at King’s College Hospital in south London may not realise it, but their experiences in clinic – both good and not so good – are helping to formulate national guidelines on how to improve standards of care nationally.

While there are many good rheumatology centres around the UK, a number of national reports published recently have reached a consensus that care of people with RA is unsatisfactorily patchy around the country.

At King’s College Hospital, Professor David Scott is one of the leading exponents of the concept of ‘total quality management’ and has been playing a big part in developing national guidelines to ensure patients receive a uniform, high standard of care and treatment wherever they happen to live.

Professor Scott also happens to be not only the head of academic rheumatology at King’s College London but also a clinician with a strong sense of responsibility for ensuring that his own patients receive timely and appropriate treatment.

As a result of this interest, the Arthritis Research UK awarded Professor Scott and his team a £300,000 programme grant, fi ve years ago. It aimed to improve patient satisfaction by developing a ‘total quality management’ approach to treatment based on the best evidence available.

Since that time, however, the national picture has changed, with the NHS developing its own emphasis on quality of care and improving the so-called patient experience.

Reports by the King’s Fund and the Rheumatology Futures Group, and guidelines from campaigning umbrella group the Arthritis and Musculoskeletal Alliance (ARMA) and the government health watchdog body the National Institute for Health and Clinical Excellence (NICE) have highlighted the weaknesses in current treatment, and suggested ways in which patient care can be improved.

King’s College Hospital should be given credit for its far-sightedness in preempting this national debate, believes David Scott’s colleague, rheumatologist

Dr Gabrielle Kingsley says:

"When I used to go around talking about these ideas colleagues thought we were bonkers!”

Adds David Scott:

"Since we started in this research, it’s become a far bigger agenda than we thought it would be; the NHS had the same idea on a bigger scale, and a lot of the ideas we put into this grant have been incorporated into national guidelines, and should revolutionise practice.”

Results of research

The results of interviews and focus groups of patients of different ages and ethnic backgrounds, as well as health professionals, resulted in some interesting, if unsurprising findings in the Arthritis Research UK programme grant. They include:

Early treatment is important

Too many people wait too long before consulting their GP with painful symptoms. GPs often fail to refer patients to a rheumatologist quickly enough. Patients should be referred within three months of persistent symptoms.

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