Quality statement 5: Annual review

Quality statement

Adults with rheumatoid arthritis have a comprehensive annual review that is coordinated by rheumatology services. [2013, updated 2020]

Rationale

Annual review is important to ensure that all aspects of rheumatoid arthritis are under control and quality of life is maximised. It provides an opportunity to assess how the person is managing their condition and to identify any further support they may need. This includes support from individual members of the multidisciplinary team. It provides an opportunity to assess disease activity and measure functional ability, check for comorbidities, such as cardiovascular disease and osteoporosis, and complications of rheumatoid arthritis, including vasculitis and disease of the spine, lung or eyes. It also provides an opportunity to establish how the disease is affecting a person's life, including any effect on work and on psychological wellbeing.

Quality measures

Structure

Evidence of arrangements to ensure that adults with rheumatoid arthritis have a comprehensive annual review coordinated by rheumatology services.

Data source: Local data collection, for example, service specifications.

Process

Proportion of adults with rheumatoid arthritis diagnosed more than 12 months ago who had a comprehensive review within the past 12 months.

Numerator – the number in the denominator who had a comprehensive review within the past 12 months.

Denominator – the number of adults with rheumatoid arthritis diagnosed more than 12 months ago.

Data source: Local data collection, for example, audit of patient records. The National Early Inflammatory Arthritis Audit collects data on provision of an annual review by rheumatology services. The Quality and Outcomes Framework (QOF) indicator RA002 collects data on the provision in primary care of a face-to-face review in the preceding 12 months.

Outcome

Health-related quality of life for adults with rheumatoid arthritis.

Data source: The National Early Inflammatory Arthritis Audit collects data for patient-reported quality of life, including symptoms, wellbeing, impact on daily life and work at baseline, 3-month and 12-month follow-up as part of the patient questionnaire.

What the quality statement means for different audiences

Service providers (rheumatology services) coordinate comprehensive annual review for adults with rheumatoid arthritis. They ensure that systems are in place to invite adults with rheumatoid arthritis to attend an annual review and ensure that all elements of the review have been completed. This includes the use of protocols to refer to members of the multidisciplinary or surgical team when necessary.

Healthcare professionals (such as rheumatology consultants, specialist registrars, specialist nurses and GPs) provide a comprehensive annual review for all adults with rheumatoid arthritis. The review includes assessment of disease activity, functional ability and development of comorbidities or disease complications. They also assess the need for referral to other members of the multidisciplinary or surgical team. They have the expertise to assess the effect the disease is having on a person's life.

Commissioners (such as clinical commissioning groups) ensure that service specifications include the provision of a comprehensive annual review for adults with rheumatoid arthritis. They monitor services to check whether these annual reviews are being done.

Adults with rheumatoid arthritis have a check-up each year. The check-up includes an assessment of rheumatoid arthritis and complications, as well as a check for heart disease, bone disease and depression. They are asked about how the rheumatoid arthritis is affecting their day-to-day life and are referred to other services (such as physiotherapy and occupational therapy) if needed.

Source guidance

Rheumatoid arthritis in adults: management (2018) NICE guideline NG100, recommendation 1.9.3

Definitions of terms used in this quality statement

Comprehensive annual review

A comprehensive annual review includes:

  • assessing disease activity and damage, and measuring functional ability (using, for example, the HAQ)

  • checking for the development of comorbidities such as hypertension, ischaemic heart disease, osteoporosis and depression

  • assessing symptoms that suggest complications such as vasculitis and disease of the cervical spine, lungs or eyes

  • organising appropriate cross-referral within the multidisciplinary team

  • assessing the need for referral for surgery

  • assessing the effect the disease is having on the person's life.

[NICE's guideline on rheumatoid arthritis in adults, recommendation 1.9.3]

The multidisciplinary team

A multidisciplinary approach to managing rheumatoid arthritis incorporates various health professions such as specialist nurses, physiotherapists, occupational therapists and podiatrists. The composition of the team may vary in an individual centre, but emphasis should be placed on the tasks required to care for the individual's needs. The adult with rheumatoid arthritis can often be an active member of the team.

[Adapted from NICE's full guideline on rheumatoid arthritis in adults, section 6.1]

Equality and diversity considerations

Adults with rheumatoid arthritis should be offered information about planning a pregnancy, pregnancy and breastfeeding at annual review. The information should be appropriate to their age and circumstances.