OP0198-HPR DEVELOPMENT OF AN INTERDISCIPLINARY NURSE-COORDINATED SELF-MANAGEMENT INTERVENTION (INSELMA) FOR PATIENTS WITH INFLAMMATORY ARTHRITIS

Abstract

BackgroundUp to 30% of patients with inflammatory arthritis (IA) do not respond sufficiently or tolerate the pharmacological treatment. Consequently, they may experience a substantial impact of their arthritis in everyday life. Even patients in remission or low disease activity state are at risk of substantial arthritis related symptoms and burden. These patients may need coherent interdisciplinary self-management support to manage symptoms and life with the chronic condition to increase their quality of life. A previous EULAR review on the effectiveness of self-management interventions in patients with IA (1) found that well-structured self-management programmes were lacking or were poorly reported.ObjectivesThis study aimed to develop a nurse-coordinated interdisciplinary self-management intervention, delivered in routine clinical care, for patients with inflammatory arthritis and with a substantial impact of their arthritis to support their self-management ability.MethodsThe study was planned across two Danish hospitals following the British Medical Research Councils (MRC) framework for developing and evaluating Complex Interventions (2). The development process consisted of four phases: 1) a comprehensive scoping review on patients support needs and elements in self-management interventions; 2) six workshops involving health professionals (rheumatologists, nurses, physiotherapists, occupational therapists, a social worker and a psychologist) and 2 patient representatives from the two hospitals and staff from primary health care, 40 people in total; the workshops focused on ideas for the content, outline of the intervention and needs for competence development of the staff; 3) self-management, self-efficacy, health literacy and principles of Acceptance and Commitment therapy (ACT) were selected as theories to tailor the intervention and 4) development of a manual through recurrent feedback from patient research partners, clinicians and the involved researchers. Two patient research partners with IA were involved in all phases of the development of the intervention.ResultsA six month nurse-coordinated interdisciplinary self-management intervention was developed (Figure 1) consisting of: 1) an initial holistic assessment is carried out by a coordinating outpatient nurse. Patients are asked to identify up to five important activities they are unable to perform or having difficulty with in accordance with the Patient Specific Functional Scale; 2) a goal-setting and action planning process involving the patient, relatives and the coordinating nurse; 3) Ongoing support to achieve the goals. The opportunities for support include individual consultations by the coordinating nurse (telephone, online or face-to-face, 2.5 hours in total), and a maximum of four consultations by a physiotherapist and or an occupational therapist. Also, support from primary care, and an online session by a social worker about social support opportunities are offered. Two team conferences led by the coordinating nurse can be held during the intervention period. A status consultation will be held after 6 months. A manual for the initial screening, inclusion, detailing the intervention, outcomes and additional materials to support the intervention was developed. Competence development of the health professionals who are to deliver the intervention was planned and completed.Figure 1.Illustration of the 6-month INSELMA interventionConclusionA nurse-coordinated interdisciplinary self-management intervention (INSELMA) was developed and described based on MRC’s framework for the development of Complex Interventions. The intervention is ready for feasibility testing before adaptation and test in a subsequent Randomized Controlled Trial.