AB1274 The effect of implementing an online patient health record aiming to promote patient participation in rheumatoid arthritis patients on the use of disease-modifying antirheumatic drugs and outcome in daily clinical practice
Authors: W.D. Müskens, S.A.A. Rongen-van Dartel, E. Adang, P.L. van Riel
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Current guidelines say that there should be a prominent place for patient participation and shared decision making in rheumatic care. To achieve this Bernhoven introduced an online patient health record (OPHR) for patients with rheumatoid arthritis (RA) aiming to facilitate self management and giving insight in the individual disease course in April 2014. This platform enables patients to monitor their disease by completing questionnaires about for instance pain, fatigue and quality of life. It also gives access to their medication history and offers patients information in the form of an online library. <h3>Objectives</h3> This study analyses how the introduction of an OPHR, aiming to promote patient participation, influences the prescription of DMARD's and the disease activity (DAS28) in daily clinical practice. A distinction was made between the effects of the PHR on patients recently diagnosed with RA (study A) and the RA population as a whole (study B). <h3>Methods</h3> In April 2014 anan OPHR for patients with RA was introduced at the rheumatology department of Bernhoven. Using data from the rheumatology department registry, two analyses were performed to evalute this implementation. Study A compared the treatment and course of DAS28 of patients diagnosed in the period three years prior to the implementation ("prior group") with those diagnosed in the period three years after the implementation ("after group"). Study B was an observational study that examined yearly trends for DMARD use and DAS28 for the whole RA population between <sup>April 2011</sup> and April 2017 <h3>Results</h3> Study A A total of 287 patients were diagnosed with RA of which 127 were in the prior group and 171 in the after group. CsDMARD's were given 160 days [95%&gt;CI 123–198] after diagnosis in the "prior group" versus (vs.) 32 days [95%&gt;CI 22–43] in the after group. Next to that there was an increase in cumulative time csDMARD's were used during follow-up, 54% vs. 74% (p-value&lt;0.001). Also, more patients received csDMARD combination therapy, 49% vs. 64% (p-value=0.001). There was no difference in number of patients that started a bDMARD, 7% vs. 14% (p-value=0.059). However, a significant larger group started with a bDMARD in the first year after start of csDMARD therapy in the after group, 3.1% vs. 9.9% (p-value 0.024). 39% of the prior group vs. 69% in the after group achieved either remission or LDA within the first year of DMARD therapy (p-value&lt;0.001). Study B The trend analysis of DMARD use in the RA population is plotted in figure 1. <sup>Between 2011</sup> and <sup>2017 a</sup> change in trend can be observed for the use of csDMARD's, the use of csDMARD combination and the use of bDMARD csDMARD combination therapy. The usage of bDMARD therapy did not change. <h3>Conclusions</h3> After the introduction of the OPHR patients recently diagnosed with RA got earlier and more intense treatment, with a more prominent role for biologicals. Next to that a bigger proportion of patients recently diagnosed with RA achieved remission and LDA within the first year of DMARD therapy. When looking for trends in the total RA population, an increase of the use of csDMARD's, the use of csDMARD combination and the use of bDMARD csDMARD combination therapy was observed after April 2014. <h3>Disclosure of Interest</h3> None declared