Nurse-led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for
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Rheumatology International https://doi.org/10.1007/s00296-020-04682-6
INTERNATIONAL
REVIEW
Nurse‑led care for the management of rheumatoid arthritis: a review of the global literature and proposed strategies for implementation in Africa and the Middle East Imad Uthman1 · Hani Almoallim2 · Christopher D. Buckley3 · Basel Masri4 · Chafia Dahou‑Makhloufi5 · Yasser El Dershaby6 · Nancy Sunna7 · Karim Raza3 · Kanta Kumar8 · Huda Abu‑Saad Huijer9 · Nabeeha Tashkandi10 · Ingrid Louw11 · Olufemi Adelowo12 Received: 14 May 2020 / Accepted: 9 August 2020 © The Author(s) 2020
Abstract Globally, increasing demand for rheumatology services has led to a greater reliance on non-physician healthcare professionals (HCPs), such as rheumatology nurse specialists, to deliver care as part of a multidisciplinary team. Across Africa and the Middle East (AfME), there remains a shortage of rheumatology HCPs, including rheumatology nurses, which presents a major challenge to the delivery of rheumatology services, and subsequently the treatment and management of conditions such as rheumatoid arthritis (RA). To further explore the importance of nurse-led care (NLC) for patients with RA and create a set of proposed strategies for the implementation of NLC in the AfME region, we used a modified Delphi technique. A review of the global literature was conducted using the PubMed search engine, with the most relevant publications selected. The findings were summarized and presented to the author group, which was composed of representatives from different countries and HCP disciplines. The authors also drew on their knowledge of the wider literature to provide context. Overall, results suggest that NLC is associated with improved patient perceptions of RA care, and equivalent or superior clinical and cost outcomes versus physician-led care in RA disease management. Expert commentary provided by the authors gives insights into the challenges of implementing nurse-led RA care. We further report practical proposed strategies for the development and implementation of NLC for patients with RA, specifically in the AfME region. These proposed strategies aim to act as a foundation for the introduction and development of NLC programs across the AfME region. Keywords Africa · Middle East · Nurse-led care · Rheumatoid arthritis · Rheumatology disease management · Specialist nursing Abbreviations ACR American College of Rheumatology AfME Africa and the Middle East AS Ankylosing spondylitis CI Confidence interval
CRP C-reactive protein DAS28 Disease Activity Score in 28 joints ESR Erythrocyte sedimentation rate EULAR European League Against Rheumatism HCP Healthcare professional
* Nancy Sunna [email protected]
7
Pfizer Inc, Amman, Jordan
8
Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
9
Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
1
American University of Beirut, Beirut, Lebanon
2
Umm Alqura University, Mecca, Saudi Arabia
3
Institute of Inflammation and Agein
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