OA23 Improving the biopsychosocial assessment and management of patients with fibromyalgia: developing a digital pre-clinic assessment tool
Authors: Saif Ahmad , Wall Amanda , Kang Youngjoo , Nicholas Jonathan , Luqmani Raashid , Soni Anushka 
Published: April 2023

Abstract

Background/Aims
Fibromyalgia syndrome (FMS) is a common and complex condition with multiple symptoms. Delivering biopsychosocial assessment and tailored management, following EULAR recommendations, is difficult due to constraints on clinic appointments. A previous audit found that only 8% of our patients with FMS were referred to a specialist rehabilitation programme and medication was the primary management recommendation in 65%. We used quality improvement (QI) methods to improve this.

Methods
A QI project was carried out with three plan, do, study, act (PDSA) cycles over 5 years (2018-2022) with the aim of improving the recording of a quantitative and qualitative assessment of pain, function, and psychosocial impact of symptoms (minimum of 80% of encounters). The proportion of consultations that documented advice on physical activity/sleep/psychological interventions, recommended medication changes, provision of written information and referral to a pain management programme was calculated. Following each cycle, a sample of consultations conducted over a 3-month period were evaluated: Cycle 1 - ‘Moving 4ward’ booklet. An assessment booklet completed by patients and clinicians at the appointment including validated screening tools, information regarding previous treatments, summary of the medical assessment, information about FMS and treatment options leading to a shared action plan. Cycle 2 - Pilot of a digital pre-clinic assessment tool (digitalising the ‘Moving 4ward’ booklet). Link sent to patients using Microsoft Forms. Results accessed by the clinician via an Excel spreadsheet during the appointment. Cycle 3 - Complete digitalisation of the pre-clinic assessment tool. Automated interpretation of results and production of a report uploaded to patient notes using an inhouse rheumatology database, RhADIO. The report includes results of screening tools, patient history as well as targeted signposting and management advice to the clinician and patient.

Results
There was an improvement in the recording of quantitative and qualitative assessment of patients with FMS across all domains (pain, function, psychological) following each cycle. In the final cycle, 100% of patients diagnosed with FMS had quantitative measures recorded on their notes and greater than 80% had qualitative assessments recorded for pain and function.
The interventions resulted in an improvement across each of the recorded management approaches in adherence to EULAR recommendations: 95% of patients were referred to a multidisciplinary pain rehabilitation service in 2022 compared to 8% at baseline. More patients were given advice on physical activity and sleep and provided written information regarding their diagnosis.

Conclusion
The project team has been able to improve the assessment and management of patients with FMS based on EULAR recommendations. Appointments are more targeted and tailored to the needs of patients based on information provided via the digital pre-clinic tool. Future work will consider how this digital tool may support all clinicians across the integrated care system in primary care, intermediate services and secondary care.
Disclosure
A. Saif: None. A. Wall: None. Y. Kang: None. J. Nicholas: None. R. Luqmani: None. A. Soni: None.