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: firstname.lastname@example.org]