AB1226 ONE YEAR‘S RESULTS OF A PROTOCOLIZED HIGH RESOLUTION RHEUMATOLOGY CLINIC
Authors: Orlando Pompei Fernández, Susana Gil Barato, Belén Álvarez Rodríguez, Juan Ramón De Dios, Margarida Vasques Rocha, Claudia Stoye, Jaime Calvo
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Mechanical musculoskeletal pathologies put high demands on the Public Health Service, as they affect a significant percentage of the population, and cause both temporary and permanent disabilities. The specialised High Resolution Rheumatology Clinic (CAR in Spanish) at our centre started up in October 2017, and focuses on the diagnosis and treatment of pathologies which are fundamentally of a mechanical ethology. The centre covers a population of approximately 328,868 inhabitants (Álava 2018 census). The aim of our study, carried out at the unit over one year, is to determine the patients' epidemiological features. <h3>Objectives:</h3> To provide the Primary Care Centres with a "fast–track" and immediate care system in order to guide, diagnose, and treat patients who have worsening acute or chronic mechanical afflictions to the musculoskeletal system. Diagnosis confirmation, request for non–accessible tests, adaptation of treatments mainly for the primary care doctor. To speed up and reduce waiting lists, for both inflammatory rheumatic pathologies and mechanical rheumatic pathologies, by establishing new referral guidelines. To draw up protocols in agreement with primary care doctors and related specialists. To act as a support for other medical services. <h3>Methods:</h3> The main services available are those offered mainly to primary care level. There are 3 clinics a week, attending to approximately 30 new patients per week. 1330 patients are included in the study, seen at the High Resolution Rheumatology Clinic (CAR) over 12 consecutive months (November 2017 – 2018), with non-complex regional pathologies and/or soft tissue rheumatism, which are able to be resolved with one or two visits. <h3>Results:</h3> 1330 patients were seen, with an average age of 58 ±15.6 years, 64.64% female and 35.36% male, mainly for musculoskeletal ailments. In order of frequency, the visits were for shoulder (25.79%), hip (16.10%), axial skeleton (15.13%), ankle/foot (13.06%), wrist/hand (12.08%), knee (11.21%), and elbow (6.63%). 61.95% of the patients were discharged after the first visit, and one year later, this figure rose to 90.15% of all the patients discharged; only 2.78% made a return visit after being discharges. 22.26% were referred to other services, mainly Traumatology and Orthopaedics (10.53%); Rehabilitation and Physiotherapy (8.72%); and the Pain Management Unit (1.65%). The 3.68% were referred to the usual Rheumatology department. For 52.33% of the patients seen, there was no need to request more than one diagnostic tests, even though 12.41% visited for reasons other than the main one. Moreover, 63.08% received some kind of infiltration injection. The negative point was that 7.89% of the referrals had been made from Primary Care to several specialists at the same time; and 7.98% were consultations regarding traumatic injuries. <h3>Conclusion:</h3> Systematising a clinic for mechanical musculoskeletal pathologies which have a high chance of being resolved in the short term, means that the quality of the care given, the waiting times, and the demand on the health service can be improved. Developing these can have important repercussions on waiting lists for other related services, and even for the Rheumatology service itself, allowing more serious cases to be seen earlier. Creating multi-disciplinary units should be encouraged, in order to improve care quality and prevent the various medical services involved from all carrying out fragmented courses of action. New guidelines could be considered, to optimise the care and management of new resources and/or links to other services, as the most prevalent pathologies can be identified. Most of the patients seen represent the economically active part of the population; there are therefore, repercussions as far as sick leave, disability leave, etc. is concerned. <h3>Disclosure of Interests:</h3> Orlando Pompei Fernández: None declared, Susana Gil Barato: None declared, Belén Álvarez Rodríguez: None declared, Juan Ramón De Dios: None declared, Margarida Vasques Rocha: None declared, Claudia Stoye: None declared, Jaime Calvo Consultant for: Bristol-Myers Squibb, Janssen, Celgene, Sanofi Genzyme, Speakers bureau: Bristol-Myers Squibb