Models and outcomes of team care for the management of rheumatoid arthritis across different countries: A systematic review.

摘要

Purpose. To identify and define models of team care in the management of patients with RA across countries and to compare the effectiveness and outcomes of these models.Methods. 25 studies were selected using pre-identified keywords (RA, Team care, etc.) from computerized databases. Studies were evaluated independently by 3 reviewers and 1 thesis advisor using Joy Macdermid's scale and Sackett's level of Evidence. Percent changes in primary outcomes (pain, disease activity, psychological status, function) were calculated to compare results across studies.Results. 25 papers report findings of 23 trials across 11 countries. Of the 23 trials, 10 assessed inpatient team care (IPT), 5 day-patient team care (DPT), 5 outpatient team care (OPT), and 3 evaluated newer team care models. 12 studies were judged of high quality (Macdermid &ge 35 and Sackett level 1b and 2b), 8 of moderate quality (Macdermid 30-34 and Sackett level 1b and 2b), and 3 studies of poor quality (Macdermid &le 29 and Sackett level 2b and 4). Most teams included a rheumatologist, nurse, physical therapist, occupational therapist and a social worker. The IPT model demonstrated the greatest improvement in pain (18% - 58%), disease activity (26% - 48%) psychological status (20% - 48%) and function (11% - 39%) across studies. Day-patients showed similar results while OPT yielded the least improvements.Discussion and conclusion. This systematic review indicates IPT and DPT produce better outcomes than OPT. However, trends in care delivery are moving towards DPT and OPT and newer models such as PTM, CNS due to changes in health care systems.