P029 Evaluating the uptake and impact of National Institute for Health and Care Excellence guidance on arthritis
Authors: Wray Jonathan , Beveridge Jennifer , Carter Victoria 
Published: April 2022

Abstract

Background/Aims
National Institute for Health and Care Excellence (NICE) impact reports review how NICE recommendations for evidence-based and cost-effective care are being used in priority areas of the health and care system. Musculoskeletal (MSK) conditions, including arthritis, affect over 20 million people in the UK, and represent a significant burden of ill health, both to the individual and the wider healthcare system. This report summarises the progress made by the healthcare system in England towards implementing NICE’s suite of guidance on arthritis.

Methods
Published data collected from national audits, reports, surveys, journals and indicator frameworks was reviewed to provide insight on the uptake and impact of NICE’s recommendations and quality standards on osteoarthritis, rheumatoid arthritis and spondyloarthritis. Stakeholders were engaged to provide expert advice and an understanding of real-world experiences and working practices. A report was produced, including examples of NICE guidance in practice, patient quotes and outcomes data, alongside uptake data. The report highlights implementation gaps and considers what NICE will do next to support the system to improve uptake in these areas.

Results
Data were presented, focusing on the following topic areas: diagnosis and management of osteoarthritis, referral and diagnosis of inflammatory arthritis, and management of inflammatory arthritis. The report highlights areas of high uptake: significant progress has been made in reducing the number of unnecessary knee arthroscopies for people with osteoarthritis; Improvements are being made towards achieving rheumatology referral targets for people with suspected inflammatory arthritis, as well as ensuring pharmacological treatment is started promptly. There is an ongoing transition to the use of biosimilar drugs as a cost-saving measure. This has reduced rheumatology drug spend by over £80 million between 2017 and 2019;. There is high provision of education and support for people with arthritis, including access to specialist advice to manage flares. The report also highlights areas where there are gaps in implementation: there is a need for improved data collection on the diagnosis and management of osteoarthritis in primary care. There is a need for the increased provision of pre- and post-surgical physiotherapy and rehabilitation for people having joint surgery. There are severe delays in the referral and diagnosis of axial spondyloarthritis, highlighting the need to raise awareness of the condition in primary care, and in other specialist secondary care areas. There is a need to improve access to psychological services for people living with a long-term physical health condition.

Conclusion
Arthritis remains one of the most significant causes of disability in the UK. Evaluating the uptake of evidence-based guidance and improving implementation is central to improving outcomes. Throughout this report, we have identified areas of high and low uptake of NICE guidance and will work closely with stakeholders to address gaps in implementation.

Disclosure
J. Wray: None. J. Beveridge: None. V. Carter: None.