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Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: A randomized controlled trial - Source: Arthritis and Rheumatism, Sep 15, 2008

  [ 5 votes ]   [ Discuss This Article ]
By ME Kroese, et al. • • September 8, 2008

Objective: To evaluate the substitution of specialized rheumatology nurses for rheumatologists in diagnosing fibromyalgia (FM).

Methods: Referred patients with FM symptoms (n = 193) were randomized to a study group diagnosed by a specialized rheumatology nurse (SRN group, n = 97) or to a control group diagnosed by a rheumatologist (RMT group, n = 96).

• SRN patients were seen within 3 weeks by a nurse who took structured history and initiated routine laboratory tests. During a 5-minute supervision session, the rheumatologist was informed by the nurse about medical history, performed a brief physical examination, and confirmed or rejected the nurse's diagnosis.

• RMT patients were seen by a rheumatologist after a regular waiting period of 3 months.

Outcome measures were:

• Initial agreement between the nurse and rheumatologist in the SRN group,

• Final diagnosis after 12-24 months of follow-up,

• Patient satisfaction,

• And diagnostic costs.


• The mean waiting time after randomization was 2.8 and 12.1 weeks in the SRN and RMT groups, respectively.

• Eight RMT patients cancelled their appointments because of the waiting time.

• Excellent agreement (kappa = 0.91) between rheumatologists and nurses was found.

• After 12-24 months of follow-up, none of the initial diagnoses were recalled in either group.

• SRN patients were significantly more satisfied than RMT patients.

• Mean diagnostic costs were lower in the SRN group (euro219) than in the RMT group (euro281) (95% uncertainty interval euro-103, euro-20).

Conclusion: Substituting specialized nurses for rheumatologists in the diagnostic process of FM is a trustworthy and successful approach that saves waiting time, provides greater patient satisfaction, and is cost-effective.

Source: Arthritis and Rheumatism, Aug 2008;59(9):1299-1305. [Epub ahead of print] PMID: 18759317, by Kroese ME, Schulpen GJ, Bessems MC, Severens JL, Nijhuis FJ, Geusens PP, Landewé RB. University Hospital Maastricht, Maastricht, The Netherlands. [E-mail:]

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