P028 An exploration of rheumatology patients’ perceptions and knowledge about sick day rules while using steroids for immunosuppression

Abstract

Abstract Background/Aims Steroids are commonly used for immunosuppression in the majority of rheumatology conditions. Patients on long-term steroids are vulnerable to adrenal insufficiency during acute illness or if steroids are stopped or weaned down abruptly. During the COVID-19 pandemic, this risk has further multiplied due to change in practice with inclusion of telephone consultations and less frequent hospital visits. Although our patients were routinely provided with steroid alert cards by pharmacy, we aim to ascertain the knowledge and understanding of sick day rules in patient who are on steroids for immunosuppression. Methods We designed a novel questionnaire consisting of 10 questions, designed to determine patients’ knowledge about steroid sick day rules. All questions were close-ended, either single best answer or yes/no except question about primary rheumatological condition and type of steroids. A total of 100 patients (including new and follow-ups) attending rheumatology clinics between January and June 2020 were screened and selected randomly. Questionnaires and consent forms were sent by post as agreed with clinical effectiveness team with return envelopes. Results 29 completely filled questionnaires were received back. The majority of patients (96.5%; n = 28) were on prednisolone and only 3.44% (n = 1) were on hydrocortisone. The majority of the patients (95.6.6%; n = 29) were on steroids for duration between 1-6 months. Answering the question on steroid dose during an acute illness,10.3% (n = 3) patients had knowledge to take double dose of steroids, 55.1% (n = 16) responded to take regular dose, 3.44 (n = 1) answered by lowering dose to half, and strikingly 10.3% (n = 3) answered to stop steroids. For further question on when to seek medical advice during an acute illness while on steroids, 31.0% (n = 9) responded by answering correctly, 37.9% (n = 11) were unsure when to take medical attention, and 3.44% (n = 1) responded to wrong option. Despite providing steroids alert cards to everyone, only 65.5% (n = 19) answered yes on asking about carrying alert card with them. Conclusion Despite providing steroid alert card and verbal information, these data highlight a significant dearth of knowledge and understanding about sick day rules among rheumatology patients on steroids for immunosuppression. This knowledge gap increases the risk of potentially life-threatening emergency of adrenal crisis among this patient group. To bridge this knowledge gap, we started to provide steroid sick day rules written information leaflet to all new and old rheumatology patients on steroids to reduce risk of future adrenal crisis. We are aiming to re audit this after 1 year to check improvement in patient knowledge and understanding of sick day rules with this change in practice. Disclosure H.M. Umair: None. W. Clark: None. R. O'sullivan: None. F. Fawthrop: None.