Patients with rheumatoid arthritis (RA) need improved access to care for a variety of reasons, most notably because there is a shortage of healthcare professionals in the field, according to the survey published in the Journal of the American Association of Nurse Practitioners. Nurse practitioners (NPs) could provide that access, the researchers wrote.

Nurse practitioners in a primary care setting can provide first-line access to health care professionals for patients who have rheumatoid arthritis, with clinical expertise, diagnostic skills, therapeutic interventions, education, and counseling, according to a new survey’s results.

An important advantage of having NPs involved in treatment is that “[RA] patients have reported less than adequate communication with their physician. … NPs working in primary care are well positioned to address patient educational needs and support shared decision making,” according to the report.

A 2012 survey of 174 NPs and physician assistants working in rheumatology found that just slightly more than half had received formal training in rheumatology, even though more than two-thirds of NPs surveyed had patients with RA.

The current study surveyed 2,301 NPs around the country, the majority of whom were certified as a family or adult NPs. Among 2,038 respondents, most of their RA patients (64.5%) were managed by a rheumatologist.

Although most respondents said they received consult notes from the rheumatologist (76.5%), 21% said they “received no feedback from the rheumatologist on shared patients.”

Asked what tools they would want for managing RA patients, nearly four-fifths desired a medication chart detailing indications and contraindications, adverse events and monitoring advice. Less than half (45.5%) wished for a decision aid to encourage patient-provider communication regarding goals of treatment.

The 2,285 NPs responding to questions about confidence in diagnosing and managing RA patients indicated a low to moderate level. Just 134 NPs (5.9%) “were very confident about diagnosing RA,” according to the report.

The most common response, given by 1,064 NPs (46.6%), was “somewhat confident.” Fully 424 (18.6%) indicated they were “not at all confident in diagnosing RA,” the researchers wrote in the article. 

However, “[it’s] important to note that nurse practitioners who participated in this survey expressed an interest in further advancing their knowledge in rheumatology in order to provide adequate care,” said corresponding author Arif Soonasra, PharmD, medical director at Pfizer.

Of the respondents, 80% wanted to know more about long-term efficacy and safety of medications, and 71.4% desired to improve their knowledge about safety profiles, according to the report. Roughly two-thirds expressed interest in “role in therapy” and “limitations of use,” and 60.7% wanted to know about “mechanisms of action.”

“[Improved] communication with treating rheumatologists, access to educational tools and resources, and further education and training may help to optimize the role of the NP in the management of RA,” Dr. Soonasra concluded.