OA24 Care priorities for people with rheumatic and musculoskeletal conditions and factors predicting dissatisfaction with care
Authors: Hollick Rosemary J , Stelfox Kevin , Bennett Louise , Lam Ka-Kin , Stevenson Michelle , Moir Laura , Macfarlane Gary 
Published: April 2023

Abstract

Background/Aims
1 in 6 of the UK population live in rural areas which can create significant challenges to delivering care. We aimed to understand priorities for care for people with rheumatic and musculoskeletal conditions (RMDs) living in rural and urban areas, and factors predicting care dissatisfaction, to support service planning.

Methods
A UK cross-sectional web-based survey of people who reported a RMD diagnosis made by a health professional. The survey was co-designed with patient partners and disseminated to charities and social media channels between 30/08/21 and 26/11/21. Using a stepwise logistic regression, independent factors related to dissatisfaction were determined. Associations are described using Odds Ratios (OR) and 95% Confidence Intervals (CIs). Survey free-text responses (n = 390) and qualitative interviews with 15 people with RMDs across the UK were analysed thematically.

Results
859 participants were eligible for the current analysis. Compared to urban dwellers, rural dwellers (256 [29.8%]) were older (% ≥ 65 years 39.5% v. 34.8%) and less likely to be from the two highest quintiles of deprivation (15.7% v. 26.9%). Overall, 373 (43%) said that current services accessed did not enable them to meet their own priorities. Rural dwellers were not more likely to express dissatisfaction with services (OR 0.91 95%; CI 0.68, 1.22). Factors significantly associated with service dissatisfaction included: demographic and socio-economic; musculoskeletal health-related factors and those linked to accessing care. The final multivariable model predicting dissatisfaction included: employment status (out of work due to illness OR 1.37); type of RMD (non-inflammatory OR 2.9); not knowing how to access available local services (OR 2.92); difficulties accessing information about their condition (OR 2.03); travel difficulties in attending health services (OR 1.42); difficulties with caring responsibilities (OR 1.59); and services not being available in local trust/health board (OR 2.46). The positive and negative predictive values for the model were both 74%. Whilst those with non-inflammatory RMDs were more likely to be dissatisfied with current services, factors influencing dissatisfaction were similar across those with inflammatory and non-inflammatory RMDs. A personal point of contact was important to facilitate access to local services and condition-specific information when required, and greater support for pain and fatigue management and self-care to meet personal goals. Rural and urban dwellers reported similar travel issues when attending health services: availability of public transport and broadband speed for remote consultations.

Conclusion
Priorities for care for people with RMDs living in rural and urban areas were similar but we have identified groups with specific needs (non-inflammatory conditions, and those unable to work because of their health). Major factors linked to dissatisfaction were lack of local services (fatigue and pain management), but even when available, access issues often led to dissatisfaction. This provides important guidance to inform service planning.
Disclosure
R.J. Hollick: None. K. Stelfox: None. L. Bennett: None. K. Lam: None. M. Stevenson: None. L. Moir: None. G. Macfarlane: None.