SAT0314\u2005IMPLEMENTATION OF AN ASSESSMENT CHECKLIST FOR PATIENTS WITH SPONDYLOARTHRITIS IN DAILY PRACTICE

Abstract

Background Nowadays, despite international and national guidelines on the evaluation and management of spondyloarthritis (SpA), several studies have depicted a sub-optimal assessment of these diseases. Objectives To analyze the feasibility and changes in the collection of clinical measures after the implementation in daily practice of a checklist designed for an optimal evaluation and monitoring of patients with SpA, including psoriatic arthritis (PsA). Methods An observational prospective study was performed. The feasibility of the assessment checklist (paper/on-line format) for patients with SpA was tested (time to complete the checklist, simplicity, amenity clarity, usefulness). Through a medical files review, changes in the number of the checklist variables collected were analyzed previous to the implementation of the checklist and 6 months later. A descriptive and bivariate analysis was performed. Results A total 6 hospitals and 11 rheumatologists participated. The median time to checklist completion was 15 (12-20) minutes, and the mean scores for the rest of variables of the feasibility test were in general positives, 6.9±1.1 (simplicity) and 6.9±0.8 (amenity), to 7.5±1.2 (clarity) and 7.5±1.4 (usefulness). A total of 83 and 68 medical files pre-implementation and post-implementation were reviewed respectively. Patient’s features were similar. Mean age at diagnosis was 42.3±1.6 and 40.3±1.3 years respectively. In both study samples around a half of patients were men, and axial SpA and PsA were equally distributed as well (40.2% and 44.8% pre- and post-implementation (47.6% and 47.8%). We observed a significant increase in the collection of many of the checklist variables after the implementation. The record of BASDAI increased from 46.2% to 73.1% (p=0.001), physical activity from 48.2% to 88.2% (p<0.0001), physician global (VAS) from 28.0% to 73.5% (p<0.0001), patient global (VAS) from 48.8% to 85.3% (p<0.0001), morning stiffness from 62.8% to 84.8% (p=0.003), ASDAS (in axial SpA) from 12.2% to 32.8% (p=0.002), BASFI from 43.7% to 65.7% (p=0.008), or DAS28 (in PSA) from 24.7% to 46.3% (p=0.006). The record of extra-articular symptoms and signs and all of the comorbidities but for osteoporosis and peptic ulcer significantly improved too. The percentage of change ranged from 20% (extra-articular symptoms and signs or arterial hypertension) to 30% (diabetes mellitus, hyperlipidemia, gout/hyperuricemia and renal failure. Other checklist variables increased but not significantly. However, some of them like the HLA-B27 or work status were already recorded (before the implementation of the checklist) in the 82.3% and 95.2% of medical files respectively. Changes were observed irrespectively of SpA classification. Conclusion The implementation of an assessment checklist in daily practice is feasible and improve the assessment of SpA patients. Acknowledgement To María Jesús García de Yébenes for her methodological support. Disclosure of Interests RAQUEL ALMODOVAR: None declared, Beatriz Joven-Ibáñez Speakers bureau: Celgene, Novartis, MSD, Pfizer, AbbVie, and Janssen, Esther Rodríguez Almaraz: None declared, Sheila Melchor: None declared, Elena Rabadan: None declared, Virginia Villaverde: None declared, Mª Teresa Navio: None declared, Laura Cebrian: None declared, Leticia Lojo: None declared, Alejandro Prada-Ojeda: None declared, Laura González: None declared, Álvaro García Martos: None declared, Victoria Navarro-Compán: None declared, Estíbaliz Loza Grant/research support from: Roche, MSD, Pfizer, Abbvie, BMS, UCB, Actelion, Celgene, Grunenthal and Sanofi, Pedro Zarco-Montejo: None declared