IMPROVE-PMR Enhanced Service
In partnership with Max Yates, Consultant Rheumatologist specialising in PMR, Norfolk and Norwich University Hospital, Norwich Epidemiology Centre, University of East Anglia and ECLIPSE (Equality of Care Led Insights for Patient Safety & Engagement).
Practice Pro Forma
Project overview
We would like to offer your practice the opportunity to take part in an enhanced pilot service for polymyalgia rheumatica, IMPROVE-PMR will support management of prednisolone prescribing and reduce potential steroid-related harms.
WHY: Polymyalgia rheumatica is a chronic inflammatory rheumatological condition which causes severe pain and disability. It is seen mostly in older people. In the over 55s prevalence is over 2% and is increasing. Diagnosis is complex and is usually made in primary care. Both primary and secondary care services provide patient care but care provision is not always seamless.
The primary treatment for PMR is prednisolone: a steroid which reduces inflammation. However, long-term treatment with prednisolone is known to cause harm including weight gain, fragile skin, fractures, and infection. NICE guidelines recommend prednisolone dose-tapering over two-years based on subjective assessment of patient wellness over approximately twelve face-to-face consultations. NICE guidelines do not use in-depth assessment of inflammatory markers for diagnosis or care. Prednisolone dose-tapering is sometimes difficult to manage, and essential tests are frequently not conducted. Patients often receive more than the recommended dose of prednisolone.
HOW: IMPROVE-PMR is fully integrated with primary care systems including clinical, prescribing, laboratory and service use datasets and can support diagnosis; effective and cost-effective management; and patient support.
Patients will be contacted by SMS, telephone or letter on your practice’s behalf by Eclipse, directing them to a lander page telling them about IMPROVE-PMR and guiding them to access their secure patient portal (using their NHS number). Patients will be asked to answer a few questions about their health and wellbeing. Patients will be supported by a trained patient engagement team.
IMPROVE-PMR will use live primary care data including inflammatory markers and objective patient self-reported wellness measures to conduct dynamic risk-stratification. The population will be segmented into dynamic low, medium and high-risk categories.
A rheumatologist will virtually review patients in the high-risk category and make recommendations for people who are living with PMR and deemed as high risk. To ensure that patients receive appropriately targeted, timely and equitable care, IMPROVE PMR will automatically send out alerts directly to GPs.
COHORTS: IMPROVE-PMR will identify and automatically engage with patients aged over 18 years who have a formal diagnosis of PMR in primary care.
EVALUATION: The pilot will run for 12 months after which a full evaluation may be undertaken. Service evaluation will be conducted via ECLIPSE and UEA. Evaluation will include health economic analysis, process evaluation, stakeholder perceptions. If IMPROVE-PMR proves effective, cost effective and acceptable to stakeholders we will present a business case to the ICB for future funding to roll the project out to further practices.
OUTCOMES: IMPROVE-PMR seeks to support population health management for older people who are prescribed long term steroids. It aims to decrease the number and impact of future events such as PMR flares or unplanned admissions, for your patients.
If your practice would like to take part: Please complete the below pro forma, expressing your interest and consent for patient engagement.