AB1404-HPR JIA TEAMWORK FOR IMPROVING PATIENTS’ ACCEPTANCE OF INTRAARTICULAR GLUCOCORTICOID INJECTIONS IN LOCAL ANESTHESIA IN OUTPATIENT DEDICATED SERVICE
Authors: Aurora Pucacco, Hanan Jadoun, Angela Aquilani, Fabio Basta, Andrea Uva, Rebecca Nicolai, Fabrizio De Benedetti, Silvia Magni-Manzoni
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The discomfort and anxiety related to the medical care of patients with juvenile idiopathic arthritis (JIA), ampered by frequent and ongoing visits, diagnostic tests, medications and hospital stays, can negatively impact on the compliance during examinations and procedures, particularly intraarticular glucocorticoid injections (IAGI) in local anesthesia. A dedicated personnel for supporting patients and their caregivers may provide them relief, thus contributing also to a more serene environment for operators. <h3>Objectives</h3> To identify an appropriate approach for the relief of JIA patients most critical issues related to IAGI in local anesthesia. To provide preliminary validation of the approach identified. <h3>Methods</h3> In the first part of the study the nurse of the IAGI outpatient service at the study center had conversation with all consecutive JIA patients and caregivers seen at the service, while preparing them to IAGI in local anesthesia and while on discharge. In agreement with the patient, the nurse synthetized in keywords and registered each patients most relevant feelings with regard to the IAGI procedure. Patients and caregivers were also asked to suggest feasible tools for a better acceptance of the procedure. The results were discussed within the JIA team, who selected in a questionnaire the most frequently reported keywords and identified the most feasible among the proposed supportive tools. Secondly, all consecutive JIA patients seen at the service were asked to complete the feeling-status questionnaire after the IAGI. As the tools were available, the questionnaire was completed after IAGI procedures tool-supported. Statistics included descriptive analysis and Students t-test for comparison between feelings rating by patients with and without supportive tools (significance: p-value&lt;0.05). <h3>Results</h3> From the list of keywords obtained by the first 10 patients with the nurse, the most reported -stress, anxiety, fear, and anger- were included in a feeling questionnaire composed of a VAS 0-10 (0=none, 10=worst) for each keyword. Among the suggested supportive tools the JIA team identified as feasible: colored drawings/pictures in the procedure room and the availability of favourite songs/videoclips/cartoons on tablet just prior and during IAGI. Forthy-one patients completed the questionnaire in a mean time of 22 seconds. Among them, 24 (59%) were supported by the selected tools, been meantime available, during IAGI procedure. *VAS 0-10, 0=none, 10=worst <h3>Conclusion</h3> Our preliminary results highlight that a setting for IAGI more comfortable for patients provide an improvement in the JIA patients feelings rating undergoing injection procedures in local anesthesia. The nurses attitude to patients and the teamwork were fundamental in collecting the patients perspective and in adapting their suggestions to the IAGI outpatient service environment. <h3>Acknowledgement</h3> We acknowledge the Associazione Malattie Reumatiche Infantili (AMREI) Onlus for its support to the initiative <h3>Disclosure of Interests</h3> Aurora Pucacco: None declared, Hanan Jadoun: None declared, Angela Aquilani: None declared, Fabio Basta: None declared, Andrea Uva: None declared, Rebecca Nicolai: None declared, Fabrizio De Benedetti Grant/research support from: Abbvie, SOBI, Novimmune, Roche, Novartis, Sanofi, Pfizer, Silvia Magni-Manzoni Consultant for: Abbvie, Speakers bureau: Abbvie