TaILOR: Trial of patient-initiated care leading to improved outcomes in rheumatology
- Musculoskeletal disease and trauma
Inflammatory arthritis is a group of conditions, such as rheumatoid arthritis, that cause joints to become swollen and painful. People with inflammatory arthritis usually require long‑term treatment with immune‑suppressing medications and are typically reviewed in outpatient clinics every 6–12 months. This accounts for around 1.3 million appointments in England each year. Many of these are unnecessary because patients are well at the time of follow‑up, wasting NHS resources and patients’ time, and reducing capacity to see people when they most need care, such as during flare‑ups.
NHS England has proposed that many people with inflammatory arthritis should no longer have routine follow‑up appointments, but instead be seen if and when they experience a flare, using an approach called patient‑initiated follow‑up (PIFU). This may offer quicker access to treatment for those in need, be more convenient and save money. However, some patients and clinicians are concerned that inflammation may be missed, resulting in poorer quality care. Evidence on PIFU to date is limited.
The TaiLOR study aims to test whether PIFU is better than standard routine follow‑up for patients.
We will conduct an economic evaluation alongside the TaiLOR randomised controlled trial, which randomises patients to PIFU (patient‑initiated appointments as required, plus a scheduled appointment at two years) or standard care (appointments every 6–12 months).
We will also analyse routine NHS data to assess the impact of PIFU on costs and resource use in routine practice.