P115 Healthcare professionals' perspectives on integrating predictive and emerging preventive approaches in rheumatoid arthritis care: A qualitative investigation
Authors: Simons Gwenda , Wells Imogen , Kanacherril Jasin P , Mallen Christian D , Raza Karim , Falahee Marie 
Published: April 2023

Abstract

Background/Aims
There is an increasing interest in treating individuals at risk of rheumatoid arthritis (RA) with preventive drugs and several clinical trials have already reported results. Once developed, a successful predictive and preventive strategy needs to be integrated in the healthcare system. The current research explores the perceptions of health care professionals (HCPs) regarding this, and factors that may affect this integration.

Methods
We conducted one-to-one semi-structured qualitative interviews (either face-to-face or by telephone) with HCPs based in the West Midlands (UK). Audio recordings of the interviews were transcribed, coded and the data were analysed by thematic analysis facilitated by NVIVO.

Results
Nineteen HCPs (11 female, 8 male) were interviewed, including ten GPs, six rheumatologists and three rheumatology nurse specialists. The coding and thematic analysis of the transcripts identified four organising themes: Attributes of predictive and preventive approaches; Ethical and psychological concerns; Implementation issues; and Learning from management of other conditions. Theme 1 described necessary attributes of predictive and preventive approaches that interviewees highlighted, including the type and performance of the predictive test, the need for a clear evidence base for preventive approaches and consideration of the risks and benefits associated with the preventive treatment. Theme 2 described the ethical and psycho-social concerns that interviewees raised, including the potential negative economic, financial and psychological effects of risk disclosure for ‘at-risk' individuals and uncertainty around the development of RA and the potential for benefit associated with the treatments being considered. Theme 3 describes the implementation issues HCPs considered, including knowledge and training needs, the costs and resource implications of implementing predictive testing and preventive treatment, the role of different types of HCPs, guidelines and tools needed for implementation and patient characteristics, such as age and family history on appropriateness of prescribing preventive treatments. Theme 4 related to the lessons that could be learned from interviewees’ experiences of prediction and prevention in other disease areas, including relevant knowledge, of how preventive treatment is prescribed, existing guidelines and tools for other diseases which could be adapted for RA prevention and issues relating to risk communication.

Conclusion
For the successful implementation of predictive and preventative approaches in RA, HCPs across primary and secondary care need appropriate training about predictive tests, test interpretation, communication of results to at-risk individuals, and intervention options. Evidence of cost-efficiency, appropriate resource allocation, adaptation of official guidelines and careful consideration of the at-risk individuals’ psycho-social needs are also needed.
Disclosure
G. Simons: None. I. Wells: None. J.P. Kanacherril: None. C.D. Mallen: Grants/research support; CM is funded by the NIHR School for Primary Care Research and the NIHR ARC West Midlands. K. Raza: Grants/research support; K.R. is supported by the National Institute for Health Research Birmingham Biomedical Research Centre. M. Falahee: None.