Specialist Nurses can diagnose Fibromyalgia Syndrome

A recent article has suggested that the use of specialised nurses in the diagnostic process of Fibromyalgia Syndrome (Fibro) is a trustworthy, successful and cost-effective approach that saves waiting time and provides greater patient satisfaction. [1]

The article, e-published ahead of print in the journal Arthritis and Rheumatism discussed a study that aimed to evaluate the substitution of specialised rheumatology nurses for rheumatologists in diagnosing Fibro. [1]

One hundred and ninety-three patients with Fibro like symptoms, who were referred for diagnosis, were randomly allocated to either a study group to be diagnosed by a specialised rheumatology nurse (SRN group) or to a control group to be diagnosed by a rheumatologist (RMT group). [1]

The patients allocated to the specialised rheumatology nurse group were seen within 3 weeks by a nurse who took a structured patient 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. [1]

The patients allocated to the rheumatologist group were seen by a rheumatologist after a regular waiting period of 3 months. [1

The outcome measures used were an initial agreement between the nurse and rheumatologist in the group of patients allocated to the specialised rheumatology nurse group, final diagnosis after 12-24 months of follow-up, patient satisfaction, and diagnostic costs. [1]

The study found that the average waiting times were 2.8 weeks for the patients allocated to the specialised rheumatology nurse group and 12.1 weeks for the patients allocated to the rheumatologist group. Eight of the patients allocated to the rheumatologist group cancelled their appointments because of the waiting time. [1]

There was excellent agreement between the diagnoses made by the rheumatologist and the diagnoses made by the specialised rheumatologist nurse. After 12-24 months of followup, none of the initial diagnoses were recalled in either group. [1]

The patients allocated to the specialised rheumatology nurse group were significantly more satisfied and average diagnostic were lower for this group (219 Euros vs 281 Euros) compared to the patients allocated to the rheumatologist group . [1]

The researchers concluded that:

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

Specialist nurses are used for a number of conditions, including neurological conditions such as Multiple Sclerosis. In general, they are found to decrease costs and increase patient satisfaction.

References:

1. Kroese ME, Schulpen GJ, Bessems MC, Severens JL, Nijhuis FJ, Geusens PP, Landewé RB. Substitution of specialized rheumatology nurses for rheumatologists in the diagnostic process of fibromyalgia: A randomized controlled trial. Arthritis Rheum. 2008 Aug 29;59(9):1299-1305. [Epub ahead of print]