• Dtsch Arztebl Int · Mar 2022

    Randomized Controlled Trial Multicenter Study

    The Structured Delegation of Medical Care Services for Patients With Inflammatory Rheumatic Diseases-Findings of a Randomized Controlled Trial (the StärkeR Project).

    • Dietmar Krause, Anna Mai, Robin Denz, Johannes Johow, Jens-Peter Reese, Benjamin Westerhoff, Renate Klaaßen-Mielke, Nina Timmesfeld, Annette Rittstieg, Ertan Saracbasi-Zender, Judith Günzel, Claudia Klink, Elmar Schmitz, Claas Fendler, Wolf Raub, Stephanie Böddeker, Friedrich Dybowski, Georg Hübner, Hans-Jürgen Menne, Heinz-Jürgen Lakomek, Michael Sarholz, Ulrike Trampisch, Hans J Trampisch, and Jürgen Braun.
    • Department of Medical Informatics, Biometry and Epidemiology, Ruhr University Bochum; Coordination Center for Clinical Trials of Philipps University Marburg; Institute of Clinical Epidemiology and Biometry, Julius Maximilian University Würzburg; BARMER Health Insurance Fund; The Ruhr District Rheumatology Center, Ruhr University Bochum; Johannes Wesling Minden Hospital, Germany, Department of Rheumatology and Physical Medicine; St. Marien Hospital Vreden, Department of Rheumatology; Specialist rheumatology practices in North Rhine-Westphalia and Lower Saxony.
    • Dtsch Arztebl Int. 2022 Mar 11; 119 (10): 157-164.

    BackgroundIn some areas of Germany, there is a shortage of specialist physicians for patients with inflammatory rheumatic diseases. Delegating certain medical care services to qualified, specialized rheumatological assistants (SRAs) might be an effective way to supplement the available capacity for specialized medical care.MethodsPatients under stable treatment for rheumatoid arthritis (RA) or psoriatic arthritis (PsA) were included in this trial, which was designed to demonstrate, in a first step, the non-inferiority of a form of care involving delegation of physicians' tasks to SRAs (team-based care), in comparison to standard care, with respect to changes in disease activity at one year. "Non-inferiority," in this context, means either superiority or else an irrelevant extent of inferiority. In a second step, in case non-inferiority could be shown, the superiority of team-based care with respect to changes in patients' health-related quality of life would be tested as well. Disease activity was measured with the Disease Activity Score 28, and health-related quality of life with the EQ-5D-5L. This was a randomized, multicenter, rater-blinded trial with two treatment arms (team-based care and standard care). The statistical analysis was performed with mixed linear models (DRKS00015526).ResultsFrom September 2018 to June 2019, 601 patients from 14 rheumatological practices and 3 outpatient rheumatological clinics in the German states of North Rhine-Westphalia and Lower Saxony were randomized to either team-based or standard care. Team-based care was found to be non-inferior to standard care with respect to changes in disease activity (adjusted difference = -0.19; 95% confidence interval [-0.36; -0.02]; p <0.001 for non-inferiority). Superiority with respect to health-related quality of life was not demonstrated (adjusted difference = 0.02 [-0.02; 0.05], p = 0.285).ConclusionTeam-based care, with greater integration of SRAs, is just as good as standard care in important respects. Trained SRAs can effectively support rheumatologists in the care of stable patients with RA or PsA.

      Pubmed     Free full text   Copy Citation     Plaintext  

      Add institutional full text...

    Notes

     
    Knowledge, pearl, summary or comment to share?
    300 characters remaining
    help        
    You can also include formatting, links, images and footnotes in your notes
    • Simple formatting can be added to notes, such as *italics*, _underline_ or **bold**.
    • Superscript can be denoted by <sup>text</sup> and subscript <sub>text</sub>.
    • Numbered or bulleted lists can be created using either numbered lines 1. 2. 3., hyphens - or asterisks *.
    • Links can be included with: [my link to pubmed](http://pubmed.com)
    • Images can be included with: ![alt text](https://bestmedicaljournal.com/study_graph.jpg "Image Title Text")
    • For footnotes use [^1](This is a footnote.) inline.
    • Or use an inline reference [^1] to refer to a longer footnote elseweher in the document [^1]: This is a long footnote..

    hide…

What will the 'Medical Journal of You' look like?

Start your free 21 day trial now.

We guarantee your privacy. Your email address will not be shared.