AB0343 DEVELOPMENT OF PERSONALISED CARE PACKAGES FOR PEOPLE WITH EARLY RHEUMATOID ARTHRITIS: A MIXED-METHODS STUDY

Abstract

BackgroundDisease management in early rheumatoid arthritis (RA) needs careful assessment of various aspects of the patient and their condition. We previously showed a need to address socioeconomic (SE) factors to improve clinical and patient-reported outcomes in RA, and benefits of a syndemics approach to care.We aimed to design a tailored care package which is acceptable, beneficial and relevant to the care of people with early RA.Objectivesi) Determine aspects of care that people with early RA find beneficial to be included in potential care packages, based on individual needs and disease characteristics; ii) determine factors considered important by patients and healthcare professionals caring for people with RA to be included in care packages.MethodsThis work comprised two stages: i) three workshops involving healthcare professionals caring for people with RA, and patients with RA, using a modified-Delphi approach; ii) online survey informed by outcomes from the workshops, featuring responses from an expanded cohort of participants from the above two groups (Figure 1).Purposive sampling was used to identify potential UK-based participants including patients, rheumatology healthcare professionals, members of national rheumatology charities, and academics with an interest in RA.The online survey was based upon: i) key themes identified by the thematic analysis from the workshops; ii) results from previous findings from quantitative datasets conducted prior to this study, e.g. SE circumstances, clinical factors, and disease outcomes. Views were sought on future ‘care packages’ for people with early RA relevant to disease progression/ stages.ResultsThematic analysis from the workshops identified two conceptual care pathways, with distinct MDT care packages, allowing for expansion of the core MDT as needed. The first pathway related to the time prior to RA diagnosis. Attendees considered this an early opportunity to potentially change the disease course, highlighting the importance of exploring risk factors e.g. obesity, smoking, social deprivation and isolation. The second pathway related to individuals with existing RA, with participants emphasising the importance of ‘the right MDT member at the right time’. Core care packages were suggested, containing three distinctive components: 1)early care package(up to 6 weeks post-diagnosis) with introduction to MDT; 2)personalised holistic care packagein collaboration with AHPs; 3)continuity of care packagebetween primary and secondary providers.Thematic analysis results also informed the survey. We received 41 responses: 17 (43%) rheumatology consultants, 7 (18%) specialist nurses, 6 (15%) rheumatology trainees, 5 (13%) occupational therapists, 3 (8%) physiotherapists, 1 (3%) patient and 1 (3%) dietician.34 (82.9%) of respondents agreed people with RA need access to the same ‘early care package’, (a core MDT) at diagnosis. A further 35 (85.4%) approved that the care package for people with early RA can be tailored to individual’s clinical, psychological and social needs at subsequent reviews.There was strong consensus for the following two statements: ‘A care package with core members of the multidisciplinary rheumatology team need to be available to people newly diagnosed with RA’ (mean 9.05, using scale 0-10) and ‘Personalised comprehensive care packages, comprising a core plus various additional members of the multidisciplinary team, need to be offered and adapted according to a person’s individual disease characteristics and socio-economic circumstances’ (mean 9.49). Fleiss’ Kappa calculations demonstrated fair level of agreement amongst respondents in the quantitative survey questions.ConclusionWe identified two care pathways with tailored care packages to optimise management in people with RA. Our results reiterate the benefits of holistic care in early and established disease. This can be further explored using syndemics to focus and better understand the relationships between bio-psycho-social factors influencing RA disease outcomes.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsNone Declared.