Trial reportBMJ (Clinical research ed.)2005
Patient initiated outpatient follow up in rheumatoid arthritis: six year randomised controlled trial.
Trial report in BMJ (Clinical research ed.), 2005. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
36 citing papers in PubMed, 5 syntheses or guidelines pooled it, 128 citations in OpenAlex.
- 2024 Update of the Asia-Pacific League of Associations for Rheumatology (APLAR) Recommendations for Rheumatoid Arthritis Management.International journal of rheumatic diseases · 2026Guideline
- Pooled it
- Patient-initiated appointment systems for adults with chronic conditions in secondary care.The Cochrane database of systematic reviews · 2020Pooled it
- Patient initiated clinics for patients with chronic or recurrent conditions managed in secondary care: a systematic review of patient reported outcomes and patient and clinician satisfaction.BMC health services research · 2013Pooled it
- Pooled it
- Self-monitoring combined with patient-initiated care in RA patients with low disease activity: cost-effectiveness analysis of an RCT.Rheumatology (Oxford, England) · 2023Trial
- Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial.Arthritis & rheumatology (Hoboken, N.J.) · 2022Trial
- Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study.BMC health services research · 2022Trial
- A patient-initiated treatment model for blepharospasm and hemifacial spasm: a randomized controlled trial.BMC neurology · 2022Trial
- Trial
- Evaluation of a patient-initiated review system in rheumatoid arthritis: an implementation trial protocol.BMC musculoskeletal disorders · 2012Trial
- The impact and utilisation of patient-initiated follow-ups (PIFU) in the elective upper-limb clinic at secondary care.Annals of the Royal College of Surgeons of England · 2026Article
- Article
- Tailoring Rheumatoid Arthritis Visit Timing Based on mHealth App Data: Mixed Methods Assessment of Implementation and Usability.JMIR formative research · 2025Article
- A theory of change for patient-initiated follow-up care in rheumatoid arthritis.BMC rheumatology · 2025Article
- Article
- Decentralizing healthcare in Norway to improve patient-centered outpatient clinic management of rheumatoid arthritis - a conceptual model.BMC rheumatology · 2021Review
- Value-Based Healthcare in Rheumatology: Axial Spondyloarthritis and Beyond.Current rheumatology reports · 2021Review
- Telemedicine in the management of rheumatoid arthritis: maintaining disease control with less health-care utilization.Rheumatology advances in practice · 2021Article
- Patient Reported Outcomes in Chronic Inflammatory Diseases: Current State, Limitations and Perspectives.Frontiers in immunology · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether direct access to hospital review initiated by patients with rheumatoid arthritis would result in improved clinical and psychological outcome, reduced overall use of healthcare resources, and greater satisfaction with care than seen in patients receiving regular review initiated by a rheumatologist.
designTwo year randomised controlled trial extended to six years.
settingRheumatology outpatient department in teaching hospital.
participants209 consecutive patients with rheumatoid arthritis for over two years; 68 (65%) in the direct access group and 52 (50%) in the control group completed the study (P = 0.04).
main outcome measuresCLINICAL OUTCOME: pain, disease activity, early morning stiffness, inflammatory indices, disability, grip strength, range of movement in joints, and bone erosion. Psychological status: anxiety, depression, helplessness, self efficacy, satisfaction, and confidence in the system. Number of visits to hospital physician and general practitioner for arthritis.
resultsParticipants were well matched at baseline. After six years there was only one significant difference between the two groups for the 14 clinical outcomes measured (deterioration in range of movement in elbow was less in direct access patients). There were no significant differences between groups for median change in psychological status. Satisfaction and confidence in the system were significantly higher in the direct access group at two, four, and six years: confidence 9.8 v 8.4, 9.4 v 8.0, 8.7 v 6.9; satisfaction 9.3 v 8.3, 9.3 v 7.7, 8.9 v 7.1 (all P < 0.02). Patients in the direct access group had 38% fewer hospital appointments (median 8 v 13, P < 0.0001).
conclusionsOver six years, patients with rheumatoid arthritis who initiated their reviews through direct access were clinically and psychologically at least as well as patients having traditional reviews initiated by a physician. They requested fewer appointments, found direct access more acceptable, and had more than a third fewer medical appointments. This radical responsive management could be tested in other chronic diseases.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.