An effective medical partnership in Nagasaki, Japan for patients with rheumatoid arthritis

Abstract

Objectives: A clear division of the roles of inpatient facilities and outpatient clinics treating patients with rheumatoid arthritis (RA) is needed. To address this, we created a medical partnership between a university hospital and 43 community clinics in Nagasaki, Japan.

Methods: We recruited the clinic physicians and compiled a list of the RA medications used (i.e. methotrexate [MTX], other disease-modifying antirheumatic drugs [DMARDs], and biologics). When a patient’s low disease activity or remission was confirmed at the university hospital, the hospital/clinic partnership provided double follow-up/medical care with semiannual meetings between the hospital and clinic physicians.

Results: We enrolled 149 patients who maintained clinical remission at 43 clinics over a 54-month period, without rare serious events. Among the nine patients who returned to the university hospital due to relapse, 66.7% had exacerbated RA within 18 months. An average 8.8–9.6 mg/week (max. 14 mg/week) MTX dose was prescribed at the clinics. The biologic usage rate was 22.1%, with a yearly increase. Among the patients treated with biologics, the DAS28ESR at enrollment was 2.65, with 58% treated with an MTX/biologic combination. A significant reduced number of patients with RA per rheumatologist were observed.

Conclusions: Maintenance of DAS remission without major adverse events was attained in the medical partnership.

Keywords:

• Clinic physician
• Lodgment institution
• Management
• Medical partnership
• Rheumatoid arthritis

Acknowledgments

We thank all of the clinic physicians who participated in this medical partnership in Nagasaki. We also thank clinical nurses Ms. Yoshie Kazaura and Ms. Reiko Tominaga for their assistance and Ms. Chikako Yamaura for her data administration.

Ethics approval

Institutional Review Board of Nagasaki University.

Conflict of interest

This work was supported in part by a Grant from The Ministry of Health, Labour and Welfare, Japan, which had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.