Quality statement 7: Annual review

Quality statement

People with rheumatoid arthritis have a comprehensive annual review that is coordinated by the rheumatology service.

Rationale

Annual review is important to ensure that all aspects of the disease are under control. It provides a regular opportunity to holistically assess the patient in terms of the current management of the disease, and any further support they may need in the future, in order to enable them to maximise their quality of life.

Quality measure

Structure: Evidence of local arrangements for people with rheumatoid arthritis to have a comprehensive annual review that is coordinated by the rheumatology service.

Process: Proportion of people with rheumatoid arthritis diagnosed more than 1 year ago whose last comprehensive review was within 12 months of diagnosis or the previous review.

Numerator – the number of people in the denominator whose most recent comprehensive review was within 12 months of diagnosis or the previous review.

Denominator – the number of people with rheumatoid arthritis diagnosed more than 1 year ago.

What the quality statement means for each audience

Service providers ensure systems are in place for people with rheumatoid arthritis to have a comprehensive annual review that is coordinated by the rheumatology service.

Healthcare professionals ensure that people with rheumatoid arthritis have a comprehensive annual review that is coordinated by the rheumatology service.

Commissioners ensure they commission services that enable people with rheumatoid arthritis to have a comprehensive annual review that is coordinated by the rheumatology service.

People with rheumatoid arthritis have a comprehensive annual review that is coordinated by the rheumatology service.

Source guidance

NICE clinical guideline 79 recommendation 1.5.1.4.

Data source

Structure: Local data collection.

Process: Local data collection. Contained within the British Society for Rheumatology National clinical audit for rheumatoid and early inflammatory arthritis and within the Commissioning for Quality in Rheumatoid Arthritis (CQRA) Patient metric data collection form for recent onset rheumatoid arthritis. See also, Quality and Outcomes Framework (QOF) indicators RA002, RA003 and RA004.

Definitions

A comprehensive annual review includes:

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

  • 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, lung or eyes

  • organising cross referral within the multidisciplinary team

  • assessing the need for referral for surgery

  • assessing the effect the disease is having on a person's life, for example their employment status and prospects (validated questionnaires are available for assessing quality of life)

  • symptom control and pain management

  • care planning

  • offering educational activities and self-management programmes.

It is not expected that all elements of the annual review would occur at the same time. Some aspects may be undertaken in primary care, for example checking for comorbidities such as hypertension.

Elements of the review may need to occur more or less often than once a year. For example, it may be most appropriate to assess for fracture risk at 24-month intervals, whereas advice on self-management or treatment review may occur more regularly.

A rheumatology service comprises a specialist multidisciplinary team, all of whom have expertise in managing rheumatoid arthritis. The team is led by 1 or more consultant rheumatologists and includes nurse specialists, physiotherapists, occupational therapists, podiatrists and orthotists. It has access to supporting specialties including orthopaedic surgery, psychology, radiology with rheumatological ultrasound and MRI experience, and may also have rheumatology doctors in training.

The rheumatology service is responsible for coordinating the annual review and ensuring that all elements have been completed (as well as preventing any duplication). An outpatient appointment could be arranged with a member of the rheumatology team to coordinate the review, and activities relating to the review should be documented in notes.

Action should be taken as necessary following the annual review, for example referral to specialist services.