Rheumatology Day Research Articles

P018 Are hospital-only specialist drugs being flagged in primary care records - a step closer toward patient safety

Abstract Background/Aims Rheumatologists prescribe many hospital-only medications (also known as red category prescriptions) including biologicals, chemotherapy such as cyclophosphamide, subcutaneous methotrexate and bosentan. The use of these medicines should be clearly communicated to primary care who should record this information in the patient’s electronic record to reduce the risk of a primary care clinician prescribing an incompatible medication and thus avoiding any potentially severe adverse events. It is also important to provide a complete list of medication when a patient is admitted to hospital acutely or referred to another department. Reflecting on a recent fatal incident, where a patient receiving subcutaneous methotrexate was prescribed trimethoprim by her GP and developed neutropaenic sepsis, our team was prompted to assess whether hospital-only prescriptions in our rheumatology cohort of patients are being flagged as a red drug in the GP system. Our objective was to determine if non-GP prescribed red drugs/hospital-only prescribed medications are being recorded in the patient’s primary care medication record. Methods We randomly selected 100 patients who attended the rheumatology day case unit from March 2021 to June 2021. We checked the newly available regional electronic patient record which contains information on medications listed on the primary care record, to see if the red drug was recorded in this record. We also recorded a patient’s age, gender, rheumatological diagnosis and the name of the hospital-only medication. Results Alarmingly, 50% of hospital-only medications were unflagged in the GP record system raising concerns about patient safety. 75% of the patients evaluated were female and their mean age was 56 (standard deviation 16.3). 61% were diagnosed with an inflammatory arthritis, of which rheumatoid arthritis was the commonest. Patients with CTD and vasculitis accounted for 39% of the population. 11% were receiving chemotherapy, 92% biologics and 12% subcutaneous methotrexate. A biological therapy was missed out more frequently compared with other categories. Conclusion A very high number of GP records did not have the hospital-only/red flag drugs recorded. This is a potential significant risk. The risk needs to be reduced by better communication between secondary care and primary care. Secondary care clinicians working in our trust can now check that the hospital only medication is correctly recorded on the GP prescribing system. If it is not recorded, then it needs to be highlighted to the GP practice in discharge letters and clinic letters. We hypothesise that this incomplete recording is not unique to our trust but a wider problem which needs to be addressed urgently to avoid preventable deaths. We propose that organisations ensure information about medicines prescribed elsewhere is reviewed on the GP clinical system at least annually, even if there are no changes to the medication. We as clinicians need to put patient safety first as an integral part of professionalism. Disclosure L. Rajagopala: None. A. Jain: None. S.Z. Chowdhury: None. D.A.E. Gamage: None. Y.A.A. Ali: None. B. Griffiths: None.

Switching from intravenous tocilizumab to subcutaneous administration during COVID-19 pandemic: impact on treatment efficacy and patient satisfaction.

We aimed to assess the efficacy and patient satisfaction of subcutaneous tocilizumab (SC TCZ) in patients previously treated with intravenous tocilizumab (IV TCZ) during the COVID-19 pandemic. We conducted a single-centre retrospective study at the Rheumatology Day Care at the Rheumatology Institute, Rambam Health Care Campus, Israel. Clinical and laboratory data of IV TCZ treated patients who switched to SC TCZ were retracted and analysed. Data were collected from the last two visits before switching to SC treatment and two visits afterwards. A telephone call conversation was conducted for all patients who continued SC treatment and did not come to follow-up visits. Forty patients (age 53.03 (± 15.7)) treated with IV TCZ were switched to SC TCZ in April-May 2020. Three patients were excluded from the study. Most of the patients were treated with TCZ for 6.35 (±2.89) years and had low disease activity. 26/37 (70%) patients discontinued SC TCZ therapy and switched back to IV TCZ. The majority of discontinuations were due to flare up of the underlying disease reflected by increased number of tender and/or swollen joints, prolongation of morning stiffness or increased pain VAS score. Two patients were hospitalised for IV glucocorticoids and 1 patient underwent knee arthrocentesis. 11/37 (30%) patients continued SC TCZ treatment. 3/11 (27%) expressed less satisfaction with SC TCZ therapy. More than half of the patients who switched from IV TCZ to SC TCZ showed signs of flare of their underlying disease or were less satisfied with SC treatment.

The Pan-American Rheumatology Day - The practice of Rheumatology in difficult times

During the health emergency x COVID-19, the limitation of face-to-face consultations allowed the widespread application of Digital Health and telemedicine tools, such as video and telephone consultations, which have been and will continue to be valuable tools to monitor patients with chronic diseases in order to identify and prioritize patients in need of medical attention.

The Pan-American Rheumatology Day - Access to doctors and medicines

The Pan-American Rheumatology Day that is celebrated on May 31st. In our Global Rheumatology podcast: Un Café por la Reumatología today we present a special program that we have called Global Conversations

E32 Drug safety knowledge of patients receiving cyclophosphamide treatment on the rheumatology day care unit: an audit

e32 Drug safety knowledge of patients receiving cyclophosphamide treatment on the rheumatology day care unit: an audit

Variability in Rheumatology Day Care Hospitals in Spain: VALORA Study

ObjectiveTo describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. Material and methodsMulticenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. ResultsA total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22.5% general, 27% major and 39.3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1000 population), and the lowest in general hospitals (2.01 per 1000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. ConclusionsThere was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity.

Quality Standards in a Rheumatology Day-Care Hospital Unit. The Proposal of the Spanish Society of Rheumatology Day Hospitals’ Working Group

BackgroundIn recent years, the Rheumatology Day-Care Hospital Units (DHUs) have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty. ObjectiveTo develop specific quality standards for Rheumatology DHUs. MethodsAfter a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared. ResultsSeventeen structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: (1) essential standards to (2) excellent standards, (3) a Rheumatology DHU services portfolio and (4) performance criteria. ConclusionsThe proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience.

THU0457 Tyms Polymorphisms and Methotrexate Therapeutic Outcome in Rheumatoid Arthritis Portuguese Patients: Analysis of Key Polymorphisms

BackgroundTherapeutic outcome of rheumatoid arthritis (RA) patients treated with methotrexate (MTX) could be conditioned by thymidylate synthase (TS) levels, which may be altered by genetic polymorphisms in TS gene (TYMS)...

AB0223 SLC19A1, SLCO1B1 and ABCG2 Polymorphisms Are Associated with Methotrexate-Related Gastrointestinal Toxicity in Portuguese Rheumatoid Arthritis Patients

BackgroundMethotrexate (MTX) is used for rheumatoid arthritis (RA) treatment with a wide variety of clinical responses1. Therefore, studies have been conducted to help elucidate the potential role of genetic polymorphisms...

SAT0555 Variability in Rheumatology Day Care Hospitals in Spain: a Descriptive Analysis of the Valora Study

ObjectivesTo describe the variability of Day Care Hospitals (DH) of Rheumatology in Spain, in terms of resources, organization, management, and quality standardsapplication. To Identify factors associated with avoidable variability and...

THU0571 A Cost Comparison Analysis of a Rheumatology Day Hospital with Nurse-Led Clinic for the Care and Management of Rheumatoid Arthritis Patients

BackgroundA great variation in the organisation of day hospitals (DH) exists in Spain. Some DH are set-up for attending only rheumatology patients, while others attend patients from different specialities and...

SAT0151 Pet/Ct Scan in Polymyalgia Rheumatica: A Prospective Study of 26 Patients.

BackgroundPolymyalgia rheumatica (PMR) may be associated with arteritis of the aorta and its major branches including temporal artery. The delay in the diagnosis of GCA and therefore, in its treatment...

Model of Excellence in Rheumatology Day Hospitals in Spain: The HD-Reumatolex Project

ObjectivesBiologics have shown greater efficacy than traditional treatments in patients with rheumatoid arthritis, although some cannot be administered on an outpatient basis. Day hospitalization requires the patient to attend the hospital for a few hours to receive those treatments that cannot be administered on an outpatient basis or that do not justify admission to hospital. Few studies have analyzed the situation of Rheumatology Day Hospitals (RDH) in Spain. The HD-Reumatolex project aims to evaluate the situation of Spanish RDHs in terms of strategy, training, management, and quality of care. Material and methodsThe project was based on a “model of excellence in RDH” design, which made it possible to perform a comparative analysis (benchmarking) of 21 Rheumatology Departments. The 19 criteria evaluated were divided into 3 categories: Strategic processes, Key processes, and Support processes. ResultsThe lowest mean scores were recorded for follow-up of clinical practice guidelines/recommendations and existence of a quality plan (Strategic processes), criteria for training among RDH professionals (Support processes), and admission and discharge (Key processes). Five RDH achieved the benchmark when the position obtained by the RDH in Key processes was plotted against the one obtained in Strategic processes and Support processes. One RDH emerged as a clear leader in the comparison. ConclusionsNone of the RDH obtained the total maximum score at the category level or at the total results level, thus revealing room for improvement in the attainment of excellence for all the participating centers.

Modelo de excelencia en el Hospital de Día de Reumatología en España: proyecto HD-Reumatolex

ObjectivesBiologics have shown greater efficacy than traditional treatments in patients with rheumatoid arthritis, although some cannot be administered on an outpatient basis. Day hospitalization requires the patient to attend the hospital for a few hours to receive those treatments that cannot be administered on an outpatient basis or that do not justify admission to hospital. Few studies have analyzed the situation of Rheumatology Day Hospitals (RDH) in Spain. The HD-Reumatolex project aims to evaluate the situation of Spanish RDHs in terms of strategy, training, management, and quality of care. Material and methodsThe project was based on a “model of excellence in RDH” design, which made it possible to perform a comparative analysis (benchmarking) of 21 Rheumatology Departments. The 19 criteria evaluated were divided into 3 categories: Strategic processes, Key processes, and Support processes. ResultsThe lowest mean scores were recorded for follow-up of clinical practice guidelines/recommendations and existence of a quality plan (Strategic processes), criteria for training among RDH professionals (Support processes), and admission and discharge (Key processes). Five RDH achieved the benchmark when the position obtained by the RDH in Key processes was plotted against the one obtained in Strategic processes and Support processes. One RDH emerged as a clear leader in the comparison. ConclusionsNone of the RDH obtained the total maximum score at the category level or at the total results level, thus revealing room for improvement in the attainment of excellence for all the participating centers.

Estado actual de los hospitales de día donde se administran los tratamientos de reumatología en la Comunidad Valenciana

Objective To evaluate and characterize the current status of the Rheumatology Day Hospital Care units in the Autonomous Community of Valencia. Material and method A structured brainstorming meeting was organized with 12 rheumatologists and a nurse and, after that, a questionnaire was sent to 20 rheumatologists to know more about the centers. Results Variability was found in the services that the day care units have for their own operation and for patient care. Rheumatologists place more importance on having some services that are not present in all centers at the moment: specialized nursing, quick drug delivery from the pharmacy and administration supervision by a rheumatologist. The following deficiencies were identified: sharing the workspaces with other specialties, drug delivery delays from the pharmacy, few resources (few spaces, few locations and little time for drug administration), lack of specialized nursing, lack of some services for patients (i.e. hot-line telephone service or patient education), few clinical sessions and lack of some procedures. Conclusions It is necessary to establish measures that lead to the resolution of deficiencies and improve the services offered to patients.

Current status of day care units where rheumatology treatments are administered in the autonomous community of Valencia

ObjectiveTo evaluate and characterize the current status of the Rheumatology Day Hospital Care units in the Autonomous Community of Valencia. Material and methodA structured brainstorming meeting was organized with 12 rheumatologists and a nurse and, after that, a questionnaire was sent to 20 rheumatologists to know more about the centers. ResultsVariability was found in the services that the day care units have for their own operation and for patient care. Rheumatologists place more importance on having some services that are not present in all centers at the moment: specialized nursing, quick drug delivery from the pharmacy and administration supervision by a rheumatologist. The following deficiencies were identified: sharing the workspaces with other specialties, drug delivery delays from the pharmacy, few resources (few spaces, few locations and little time for drug administration), lack of specialized nursing, lack of some services for patients (i.e. hot-line telephone service or patient education), few clinical sessions and lack of some procedures. ConclusionsIt is necessary to establish measures that lead to the resolution of deficiencies and improve the services offered to patients.

Two Brief Versions of the Multidimensional Pain Readiness to Change Questionnaire, Version 2 (MPRCQ2)

The present study sought to develop 1-item and 2-item versions of subscales from the Multidimensional Pain Readiness to Change Questionnaire, Version 2 (MPRCQ2), a measure of readiness to adopt a variety of pain management and coping strategies commonly taught in multidisciplinary treatment programs. One hundred and ninety patients with rheumatic diseases who entered a Rheumatology Day Program completed the MPRCQ2 and an additional criterion measure, the Pain Stages of Change Questionnaire (PSOCQ), before and after treatment. First one and then a second item that best represented each MPRCQ2 scale were selected based on: (1) the correlations between the items and their parent MPRCQ2 scale; (2) responsivity to change following treatment; (3) correlations of the items with the PSOCQ scales; and (4) authors' consensus of face validity and construct representativeness of items. The psychometric properties of the 1-item and 2-item versions of the MPRCQ2 scales were then examined. These brief versions provided good approximations of their parent scales and 9/10 were responsive to change following multidisciplinary treatment. Correlations between the brief scales and the PSOCQ scales showed similar relationships as with the full MPRCQ2 scales. The findings support the validity of these brief versions of the MPRCQ2 subscales. We would recommend the use of these versions of the MPRCQ2 when a measure of patient readiness to use a range of pain self-management coping strategies is needed (eg, treatment process research, prediction of success in multidisciplinary treatment), but response burden is a significant issue.

Cognitive/behavioral approaches: Providing web-based treatment follow-up services for chronic pain management programs: Ethical concerns, professional issues and design considerations

Multidisciplinary chronic pain treatment programs teach patients to incorporate symptom-management strategies into their daily routine, including exercise, activity pacing, proper body mechanics, relaxation and cognitive-behavioural strategies for stress and emotional distress. Such programs have been shown to result in decreased pain, disability levels and health care utilization, and improved psychosocial functioning. However, many patients are unable to maintain these significant lifestyle changes long-term. Patients attending our multidisciplinary Rheumatology Day Programs have identified a need for treatment follow-up to facilitate long-term maintenance, but these services are limited due to current staffing constraints. The Arthritis Institute Internet Clinic (AIIC) was proposed as a means to offer novel, cost-effective follow-up treatment through both education and interactive, on-line problem-solving / relapse prevention workshops. This presentation will provide an in-depth examination of the ethical and professional issues involved in providing web-based treatment services. Existing guidelines for web-based health care and research will be reviewed, addressing issues such as the informed consent process, participant privacy and confidentiality, clinician – client communication, and professional accountability. Challenges faced during the program development phase of the AIIC will highlight the fact that development of comprehensive ethical and professional guidelines for web-based treatment and research has not kept pace with rapid advances in the field of e-health. Specific guidelines and practical solutions will be provided for a number of ethical concerns and professional dilemmas faced in the development of the Arthritis Institute Internet Clinic. Future research will examine patients' willingness to use web-based follow-up treatment services, and will determine if web-based treatment follow-up services will result in improved disease management and decreased health care utilization.

Rheumatology day care and the impact of biological therapies--the Belfast experience

Rheumatology day care and the impact of biological therapies--the Belfast experience