The Rheumatology Monitoring Clinic in Singapore — A Novel Advanced Practice Nurse-/Pharmacist-Led Clinic

Abstract

Due to the increasing demand for healthcare services worldwide, there is a need for innovative changes in the provision of healthcare. The introduction of advanced practice nurse (APN)- and/or pharmacist-led outpatient clinics is an emerging trend in many countries. The Rheumatology Monitoring Clinic (RMC) started in Singapore General Hospital (SGH) in 2009, as a new healthcare delivery service model, led by APNs and pharmacists. The aim of the RMC is to ensure that stable patients with rheumatoid arthritis and spondyloarthritis on disease modifying anti-rheumatic drugs (DMARDs) are monitored regularly and appropriately for drug toxicity. The benefit of having such a model of care in a local tertiary centre is to deliver right-siting of care for stable patients, hence allowing more clinic slots for rheumatologists to see new patients, and those with complex diseases. A survey conducted on the RMC showed that it received positive feedback from patients, with an overall high degree of satisfaction. We thus established the acceptability of a non-physician-led clinic in our local setting. Based on the success of the RMC, the scope has been extended to monitor patients on newly initiated DMARDs and escalation therapy. Additionally, an APN-led telephone clinic (the Virtual Monitoring Clinic [VMC]) has been introduced, offering cost-effective healthcare, personalised service, and convenience to patients. This review aims to summarise the role and model of care of a novel RMC in Singapore, discuss the key roles of APNs/pharmacists, and describe the outcomes of the RMC audit and survey.