Development and Evaluation of a Clinic for Elderly Patients with Rheumatoid Arthritis and Multimorbidity: A Pilot Study

ObjectiveIntegrating patient's and physician's goals, especially in elderly patients with multimorbidity, might ultimately improve care. Efforts to develop such care innovations in patients with rheumatoid arthritis (RA) are lacking. The objective of our study was to develop and to pilot test a clinic for elderly patients with RA and multimorbidity.MethodsFirst, a referral strategy for and the content of an Elderly Multimorbidity Clinic (EMC) was developed. Next, the EMC was implemented, and it primarily focused on the personal goals of patients and medication review. The EMC was evaluated in a quantitative-qualitative approach.ResultsReferral considered useful by the rheumatologist was chosen as the referral criterion. A rheumatologist and internist-geriatrician provided care to referred patients (>= 55 years) at the EMC during three visits over 1 year. Twenty patients with RA participated in the pilot study (mean age 76.87.7 years; 30% male). Only 12 (60%) patients attended the first follow-up consultation, and three (15%) attended the second follow-up consultation. During any follow-up visit, 9/12 (75%) patients achieved one or more goals. Examples of accomplished goals were reduction of medication and improvement of mobility. In 19/20 (95%) patients, medication was remediated (stop medication for 13 patients; start medication for five patients) during the first visit. After 1 year, medication was changed back in 10 patients. Rheumatologists revealed uncertainty about meaningful referral, and patients and rheumatologists mentioned high (caregiver) burden because of extra visits as reasons for not attending follow-up. Patients were satisfied with the care provided.ConclusionThis goal-directed EMC led to the accomplishment of at least one goal in 75% of patients. Sustained benefits could not be demonstrated because of low follow-up.