P109 Personalised comprehensive care packages for people with rheumatoid arthritis: a survey-based study
Authors: Dey Mrinalini , Busby Amanda D , Lempp Heidi , Nikiphorou Elena 
Published: April 2023

Abstract

Background/Aims
Socioeconomic and clinical factors are closely associated with long-term disease outcomes in rheumatoid arthritis (RA). There is increasing evidence for holistic, targeted management of people with RA, including at first presentation. This study aimed to determine how people with, and those involved in the treatment of RA, benefit from personalised care packages and treatment programmes.

Methods
An online survey was developed by an expert panel comprising physicians, psychologists, epidemiologists and patients, following three multidisciplinary workshops which included patients. Questions were designed to evaluate participants’ views on multidisciplinary Team (MDT) involvement in the care of patients at early-stage RA and onwards. The online survey underwent extensive revisions by patients and clinicians, before dissemination to patients and healthcare professionals (HCPs) in the UK.

Results
We received 41 complete responses: 23 (57.5%) rheumatology consultants/trainees, seven (17.5%) rheumatology specialist nurses, five (12.5%) occupational therapists, three (7.5%) physiotherapists, one dietician (2.5%) and one patient (2.5%). 82.9% of respondents agreed that people with RA need access to the same “early” care package (comprising a core MDT) at time of diagnosis. On subsequent clinical reviews, 85.4% of respondents agreed that the care package for people with early RA may need to be tailored to an individual’s clinical, psychological and social needs. 58.5% of respondents confirmed that a standard core packaging with input from a consultant rheumatologist, clinical nurse specialist/patient educator, general practitioner and pharmacist is appropriate for patients with early RA, irrespective of patient or disease-related factors; 36.6% disagreed and 4.9% were unsure. Of those disagreeing with this statement, 36.7% agreed not all of these healthcare professionals are relevant to patient care at time of diagnosis, whilst 53.3% gave another reason and 10% were unsure. 68.3% of participants suggested additional involvement of 1-6 MDT members in patient care, specifically occupational therapists, physiotherapists and psychologists. Other posited that primary care may be included occasionally, and additional MDT members’ expertise in early disease may be overwhelming and require frequent review. There was strong agreement (median 10/10 on Likert scale) for the following two statements: ‘A care package with core members of the multidisciplinary rheumatology team need to be available to people newly diagnosed with RA’; ‘Personalised comprehensive care packages, comprising a core plus various additional members of the multidisciplinary team, need to be offered and adapted according to a person’s individual disease characteristics and socio-economic circumstances’.

Conclusion
HCPs caring for people with RA overwhelmingly agree with a tailored MDT involvement from an early stage of disease, reviewed regularly and adapted. Care packages need to be personalised to account for bio-psycho-social factors. HCPs need to acknowledge that the “ideal” care package may vary markedly between patients to maximise impact and benefit for patients.
Disclosure
M. Dey: None. A.D. Busby: None. H. Lempp: None. E. Nikiphorou: None.