OP0307 STANDARDS OF CARE FOR RHEUMATOID ARTHRITIS: GAPS IN IMPLEMENTATION EXPERIENCED BY PATIENTS AND RHEUMATOLOGISTS ACROSS 33 EUROPEAN COUNTRIES
Authors: Rachelle Meisters, Polina Putrik, Sofia Ramiro, Monika Hifinger, András Keszei, Yvonne van Eijk-Hustings, Anthony Woolf, Josef S. Smolen, Tanja Stamm, Michaela Stoffer-Marx, Till Uhlig, Rikke Helene Moe, Maarten de Wit, Annelies Boonen
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Eumusc.net, a EULAR and EU supported initiative (which took place from 2008 to 2013) aimed to raise and harmonize quality of care for patients with rheumatic and musculoskeletal diseases across European countries. As part of Eumusc.net, 16 user-focused standards of care (SoC) for rheumatoid arthritis (RA) were developed. <h3>Objectives</h3> To evaluate gaps in quality of care using the Eumusc.net SoCs among patients and rheumatologists across Europe and to investigate the contribution of individual- and country-level characteristics to care gaps <h3>Methods</h3> Fifty RA patients and 50 rheumatologists from each of 34 countries were invited to participate in a survey. For each SoC, levels of importance and care were rated for received by patients or provided by rheumatologists on a scale from 0 to 10 (=best). Care gaps were calculated as difference from the maximum score for care received multiplied by the score for importance of care [0 (no gap) -100], and defined as ‘problematic’ when the gap was &gt;30 and importance ≥6. Individual- and country-level (GDP in tertiles) determinants of care gaps were analysed in multilevel logistic regression models, with patients clustered in country of residence. For patients, individual factors included gender, age, disease duration (years), level of education (low, high), work status (retired, disabled, working, not working), literacy, patient organisation membership and overall health (0-10). For rheumatologists, individual factors were gender, age, years of experience and work setting (university hospital and non-university hospital/private practice). <h3>Results</h3> In total, 1,422 patients from 27 and 1,044 rheumatologists from 33 European countries, respectively, were included. Patients had a mean (SD) age of 57.2 (13.2) years and 74% were female. For rheumatologists, the mean age was 47.7 (10.5) and 53% were female. After ranking the SoCs on percentage of problematic gap, the 7 SoCs in the top 10-ranks for both patients and rheumatologists (Table) were: <i>diagnosis within 6 weeks</i>, <i>information about patient organisations</i>, <i>availability of treatment plan</i>, <i>receiving a schedule of regular assessment</i>, <i>vaccination-related information</i>, <i>information about adequate physical exercise</i> and <i>training on aids, devices and ergonomic principles</i>. The least frequent problematic SoC for both patients and rheumatologists was <i>adequate DMARD received (</i>6% and 3%<i>)</i>. Multilevel analyses revealed large variation across countries for patients (all models p&lt;0.01) and for the majority of analyses for rheumatologists, despite adjustment for individual characteristics. In addition, patients with higher education and lower self-reported health experienced problematic gaps more frequently. Among rheumatologists, patterns in determinants across SoCs were less consistent. For about half of the SoCs, rheumatologists from lower GDP countries identified problematic gaps more often compared to those from medium or high GDP countries (see Table). <h3>Conclusion</h3> For most SoCs, problematic gaps were identified in essential aspects of RA care, and substantial differences across countries were observed. In general, patients identified problematic gaps in SoCs more frequently than rheumatologists did. These findings can help to evaluate quality of care and to work towards improvement of care for RA patients in Europe. <h3>Disclosure of Interests</h3> Rachelle Meisters: None declared, Polina Putrik: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant for: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Speakers bureau: AbbVie, Lilly, MSD, Novartis, Pfizer, Sanofi, Monika Hifinger Employee of: Monika is employed by a pharmaceutical company. However, during the study she was on maternity leave and the company was not involved in the study., András Keszei: None declared, Yvonne van Eijk-Hustings Grant/research support from: UCB, Speakers bureau: Cellgene, Anthony Woolf: None declared, Josef S. Smolen Grant/research support from: AbbVie, Eli Lilly, Janssen, MSD, Pfizer, Roche, Consultant for: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Speakers bureau: AbbVie, Amgen, Astra-Zeneca, Astro, Celgene Corporation, Celtrion, Eli Lilly, Glaxo, ILTOO, Janssen, MedImmune, MSD, Novartis, Pfizer, Roche, Samsun, Sanofi, UDB, Tanja Stamm Grant/research support from: TS has received grant support from AbbVie., Paid instructor for: TS has received speaker fees from AbbVie, Janssen, MSD, Novartis, and Roche., Michaela Stoffer-Marx: None declared, Till Uhlig Consultant for: Grünenthal, Novartis, Speakers bureau: Grünenthal, Novartis, Rikke Helene Moe: None declared, Maarten de Wit: None declared, Annelies Boonen: None declared