Nursing triage in rheumatology: three months experience in an outpatient clinic of the university of florence

Background: At present patients with rheumatic diseases are mainly assisted
in outpatient settings. In our centre more than 150 patients with SSc (Systemic
Sclerosis) and more than 100 patients with SPA (Spondyloathritis) are treated
monthly. Rheumatic diseases are chronic conditions associated with disability,
reduced quality of life and emotional and social consequences. Nurses’ role
is crucial in improving rheumatic patients’ global health providing educational
support, promoting self-management and helping accessing appropriate services
when needed.
Objectives: To describe nursing triage in rheumatology – A nurse led service
focused in monitoring disease activity, symptoms and complications and
providing educational and clinical support. Nursing triage takes place before
rheumatologists’ assessment. Period of observation: 1/12/2013 – 28/2/2014
Methods: All SSc and VEDOSS patients were evaluated for Raynaud Condition
Score (RCS), sHAQ, SScQoL, HAMIS, Cochin, Borg, IIEF5. DUs and other skin
lesions were assessed. All SPA patients were evaluated for MASES, BASMI,
BASDAI, BASFI, swollen and tender joints, tender points and sacroiliac joint pain.
BP, BMI were available for all patients. A severity index based on the previous
tests’ scorings was obtained both for SSc and SPA patients. Severity index for
SSc/VEDOSS was based on DUs presence, sHAQ, HAMIS, Cochin, Borg, RCS
and ranges between 0 and 7 (0=lowest severity; 7=highest severity). Severity
index for SPA was based on all the previous evaluations and ranges between 0
and 10 (0= lowest severity; 10= highest severity).
Results: 264 patients were treated in SSc/VEDOSS outpatient clinic (51
VEDOSS, 71 SSc, 7 primary RP, 98 secondary RP whose diagnosis had to be
confirmed). DUs occurred in 29,41% of SSc patients, in 4,08% of patients with
secondary RP, no DUs were found in VEDOSS patients. DUs were significatively
associated with global and hand impairment and with reduced QoL (p<0,05). In
SSc patients severity index, RP severity, overall and hand disability were more
severe than VEDOSS patients (p<0,05). SPA patients had a mean severity index
of 3,85; ds 2,67. The overall disability was low (BASFI mean value 2,32; ds 2,56),
the disease activity was high (BASDAI mean value=4,09; ds 2,62).
Conclusions: SSc and VEDOSS patients with severity index=0 and SPA patients
with severity index≤1 may be followed mainly by nursing staff with interventions
based on lifestyle modifications and non-pharmaceutical therapies. Adequate
protocols must be approved by rheumatologists staff. In this context a nurse led
helpline may be effective to select the most appropriate site and level of care for
acute conditions in rheumatic diseases.