456. Remote clinical management using electronic assessment of patients with vasculitis
Creators: name: Raashid Luqmani1
Publisher: name: Zenodo
Year: 2022
Subjects: Vasculitis
ANCA
Abstracts
Giant Cell Arthritis
MPA
GPA
EGPA
Takayasu
IgA vasculitis

description: <strong>Background/ Objectives:</strong> The aim of this project was to develop generalizable digital solutions to help deliver safe, efficient and effective care for patients with long-term rheumatic conditions. We have previously demonstrated that this method is feasible and acceptable to patients with rheumatoid arthritis (RA) and spondyloarthritis (AxSpA). We evaluated the outcomes of remote assessment across a further range of conditions, including vasculitis, connective tissue diseases (CTD) and psoriatic arthritis (PsA). <strong>Methods:</strong> We developed a set of online questionnaires using readily available software to conduct a remote assessment in 806 patients awaiting follow-up appointments in rheumatology (delayed as a result of the Covid 19 pandemic). The questionnaire contained measures of disease activity; patient reported outcomes; patient preferences regarding the urgency and type of appointment required; and any other recent problems or changes in medication highlighted by the patient. For vasculitis we designed a self-assessed Birmingham Vasculitis Activity Score (BVAS) and used the published ANCA associated vasculitis patient reported outcome measure (AAVPRO). The information was imported into a bespoke clinical database allowing clinicians to conduct an asynchronous assessment, integrated within our electronic health records (EHR). Report letters were sent to the patient and their general practitioner. EHRs were reviewed in a subset of patients requiring urgent in-person assessments (within 1-month) following remote assessment: disease activity assessments were compared and treatment changes evaluated, using Chi-square test to investigate for significant differences by condition. We defined “stable” disease as patients classified as in remission or partial remission, on or off immunosuppressive therapy. <strong>Results:</strong> Table 1 summarises all the patients assessed remotely, by condition, and subsequent follow-up requested. Patients with CTD (9%) or vasculitis (11%) were least likely to require a face to face appointment within 3 months of assessment compared to other conditions (PsA 31%, RA 28%, AxSpa 21%). Agreement between remote and in-person assessment was evaluated in 56 patients (25 RA; 14 PsA; 17 AxSpA). Agreement was present in 21/25 (84%), 9/14 (65%) and 12/17 (71%) of patients with RA, PsA and AxSpA respectively, p=0.35. Treatment changes were made in 21/25(84%), 9/14(65%), 11/17(65%) of patients with RA, PsA and AxSpA respectively, p=0.26). <strong>Conclusions:</strong> We have developed and implemented a system of remote clinical management for patients with rheumatic conditions. Following remote assessment only 284/806 (35%) required a subsequent in-person assessment and 351/806 (44%) were stable. Concordance with in-person assessment was highest for patients with RA, but not significantly different to outcomes for PsA and AxSpA. Further work is needed to validate this mode of assessment (compared to in person evaluation) in patients with vasculitis and CTD as well as those declared as having “stable” disease. <strong>Disclosures:</strong> Grant from Pfizer Global to develop remote monitoring system for rheumatoid arthritis