P108 Exploring the Treatment Burden of Disease Modifying Anti-Rheumatic Drug Monitoring in People with Rheumatoid Arthritis: A Qualitative Study with Recommendations for Practice
Authors: Ryan Sarah J , Bullock Laurna , Manning Fay , Paskins Zoe , Chew-Graham Carolyn 
Published: April 2023

Abstract

Background/Aims
People with rheumatoid arthritis (RA) taking disease-modifying anti-rheumatic drugs (DMARDs) require safety monitoring to identify potential side-effects. This study explored patients’ and family members’ perspectives on DMARD monitoring, and how associated treatment burden could be minimised to optimise concordance and safety.

Methods
Adults with RA on DMARDs and family members were recruited from 2 rheumatology departments in the West Midlands to take part in semi-structured telephone interviews between July 2021 and January 2022. Public contributors with RA helped to develop the topic guide and interpret the results. Interviews were digitally recorded and data analysed using a framework method. Findings were discussed with a group of stakeholders to develop implications for practice.

Results
Thirteen people with RA (10 females, age range 40-79yrs, seven retired, disease duration 1 month-21 years) and 3 family members (male, retired, aged 70 to 79 years) participated in an interview. Three main themes were identified: 1) DMARD monitoring took precedence over the work involved. 2) Inflexibility with appointment times and travel requirements increased the work for patients and families. 3) Drug Monitoring was more than safety surveillance. DMARDs were considered a necessity to treat active disease and maintain wellbeing. Consequently, the work associated with DMARDs monitoring was often accepted in return for control of symptoms. Treatment burden was not always recognised, as early appointment times increased the work for patients with physical care needs and those with co-morbidities, who required extra time for preparation. Inflexibility in drug monitor locations impacted on the personal, practical and financial costs associated with travelling and parking, with family members having to take time off work. Monitoring encompassed more that drug safety addressing symptom management, functional ability and emotional wellbeing. Three core recommendations for addressing treatment burden to optimize concordance and safety were co-designed by the stakeholders (3 rheumatology nurses, 3 clinical academics, 2 rheumatologists, 1 GP and 1 person with RA) and the research team: 1) Conceptualising monitoring: changing the emphasis of care from ‘drug’ monitoring to ‘person’ monitoring to facilitate a holistic assessment of the person and their condition. 2) Identifying treatment burden: being clear who within the healthcare team is identifying treatment burden and when. Proactively, assessing treatment burden when a DMARD is commenced, rather than waiting for burden to exceed capacity, resulting in non-concordance. 3) Minimising treatment burden: by negotiating how treatment burden can be managed including offering flexible and responsive options, in terms of appointment times and monitoring locations.

Conclusion
The work involved for people with RA in drug monitoring is significant and often unrecognised. Our findings have led to clear recommendations to promote a more person-centred approach, increase recognition of, and minimise the treatment burden associated with DMARD monitoring.
Disclosure
S.J. Ryan: Royalties; book royalties oxford handbook clinical rehabilitation 5600006372. Grants/research support; General Nursing Council Trust. Other; unpaid committee role with the haywood foundation. L. Bullock: None. F. Manning: Grants/research support; NIHR Applied Research Collaboration South West Peninsula. Other; Honorary lectureship in bone health Keele University. Z. Paskins: Consultancies; non paid consultancy for UCB. Grants/research support; versus arthritis, royal osteoporosis society, general nursing council trust, charted society for physiotherapy, british society for rheumatology. Other; unpaid committee roles with royal osteoporosis society, versus arthritis and haywood foundation. C. Chew-Graham: Royalties; for a book primary care mental health 9781911623021. Grants/research support; NIHR and other funding bodies for research.