ADHERENCE TO TREAT-TO-TARGET RECOMMENDATIONS IN PATIENTS WITH INFLAMMATORY ARTHRITIS: AUDIT OF RHEUMATOLOGY ANP-LED CARE VERSUS USUAL CARE

Background: Inflammatory arthritis (IA) poses a significant burden on patients and healthcare systems. The treat-to-target (T2T) management approach has emerged as a pivotal strategy for optimising treatments with tighter control of disease activity, resulting in improved patient-reported outcomes. Barriers exist to implementing T2T in clinical practice. Individualised care delivery and internal system issues, such as follow-up visit scheduling, can be improved with the addition of highly trained personnel and improved infrastructure to provide scope for the expansion of services. The Rheumatology unit of a large university teaching hospital in the Republic of Ireland sought and secured an ANP post to implement T2T recommendations in patients with IA from January 2021 onwards. Objectives: To evaluate the impact of Rheumatology ANP-led care versus usual care on adherence to T2T recommendations in patients with IA. Identify actions that must be undertaken to meet standards not achieved by ANP-led care. Methods: A retrospective review of written medical records was undertaken in October 2023. To assess routine care, a random sample of 20 charts from patients who received one full year of usual care between January 2017 and July 2021 were examined. Patients had a documented early diagnosis of IA by a Rheumatologist and were prescribed a disease modifying antirheumatic drug (DMARD). To compare compliance to T2T recommendations against ANP-led care, another random sample of 20 charts from patients with early IA who received one full year of ANP-led care between January 2021 and July 2023 were analysed. All 40 charts (20 usual care and 20 ANP-led care) were reviewed seeking written evidence that each standard adapted from Batko et al. (Table 1) was referenced. Results: Overall compliance to the T2T recommendations was 97% for ANP-led care versus 50.5% for usual care. 100% (n=20) of ANP led care charts met compliance for standards 1, 3, 4, and 5. Usual care achieved 100% (n=20) compliance for standards 3 and 4. ANP-led care achieved 85% (n=17) compliance for standard 2. Regarding usual care there was a 0% compliance rate for standard 1, 7.5% (n=3) compliance with standard 2, and 45% (n=9) compliance with standard 5 (Figure 1). Conclusion: Setting goals and regular review in the early stages of disease has been shown to improve outcomes since the seminal work done in 2009 by Klarenbeek et al. Shared decision making improves patient compliance as shown by Deniz et al. In three of the five standards relevant to the aforementioned, ANP led care is significantly better than usual care. REFERENCES: [1] Smolen JS, Breedveld FC, Burmester GR et al. Treating rheumatoid arthritis to target: 2014 update of the recommendations of an international task force. Ann Rheum Dis. 2016 Jan;75(1):3-15. doi: 10.1136/annrheumdis-2015-207524. Epub 2015 May 12. PMID: 25969430; PMCID: PMC4717393. [2] Batko B, Batko K, Krzanowski M et al. Physician Adherence to Treat-to-Target and Practice Guidelines in Rheumatoid Arthritis. J Clin Med. 2019 Sep 8;8(9):1416. doi: 10.3390/jcm8091416. PMID: 31500394; PMCID: PMC6780913. [3] Klarenbeek NB, Allaart CF, Kerstens PJ, et al. The BeSt story: on strategy trials in rheumatoid arthritis. Curr Opin Rheumatol. 2009 May;21(3):291-8. doi: 10.1097/BOR.0b013e32832a2f1c. PMID: 19318946. [4] Deniz S, Akbolat M, Çimen M, et al. The Mediating Role of Shared Decision-Making in the Effect of the Patient-Physician Relationship on Compliance With Treatment. J Patient Exp. 2021 May 20;8:23743735211018066. doi: 10.1177/23743735211018066. PMID: 34179444; PMCID: PMC8205395. Table 1. Treat to target standards of care [3] Standard Descriptor 1 Treatment target defined at outset (medium, low, remission) 2 Regular assessment and ≥ 5 visits within first year of DMARD initiation 3 Evidence of a physical examination and clinical history 4 Treatment adjusted if indicated and rationale documented if not 5 Evidence of shared decision making Figure 1. Overall compliance with recommendations and percentage compliance per standard of care Acknowledgements: NIL. Disclosure of Interests: Louise Murphy Presented at meetings sponsored by: Abbvie, Pfizer, Novartis, Janssen, Nordic Pharma, Boehringer Ingelheim, UCB, BMS, Celltrion, and Roche, Grainne Murphy Presented at meetings sponsored by: UCB, Abbvie, and Novartis, Department of Rheumatology, CUH, has received funding for research from Abbvie, not relevant to current submission, John Ryan Presented at meetings sponsored by Abbvie and Janssen, Sinead Harney Presented at meetings sponsored by Pfizer, Abbvie, Novartis, Galapagos, and Janssen. DOI: 10.1136/annrheumdis-2024-eular.1223 Keywords: Best practices, Nursing, Quality of care, Health services research Citation: , volume 83, supplement 1, year 2024, page 2187Session: HPR Implementation and service evaluation (Publication Only)

Best practices, Nursing, Quality of care, Health services research