AB1422-HPR MODERATE AND HIGH ADHERENCE TO A DISEASE MANAGEMENT MODEL IN PATIENTS WITH RHEUMATOID ARTHRITIS IMPROVES CLINICAL RESULTS IN A BIG UNICENTRIC COHORT
Authors: Laura Villarreal, Fernando Rodriguez, Michael Cabrera, Pedro Santos-Moreno
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Rheumatoid arthritis (RA) is an inflammatory, chronic disease of unknown etiology. Usually it leads to deformity and destruction of joints through the erosion of cartilage and bone. Over 90% of patients with RA report to suffer symptoms in hands and joints, swelling, loss of motion, muscle weakness among others. These symptoms affect all aspects in a patients life. Therefore, management of a patient with RA should not only include evaluate outcomes related to the rheumatology specialty, on the contrary, aspects such as physical disability, nutrition, mental health, among others should be taken into account. Centers of excellence in rheumatoid arthritis have proposed a multidisciplinary model of care with an initial diagnosis, treatment prescription and follow-up with a rheumatologist, periodic consultations with a physiatrist, psychologist, physiotherapist, occupational therapy nutrition, and, a patient focused program. With a multidisciplinary model of care the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. <h3>Objectives</h3> The aim of this research was to define adherence/attendance to a multidisciplinary model of care for patients with RA that attend to a RA specialized center in Colombia. <h3>Methods</h3> We implemented the center of excellence model program proposed by REAL-PANLAR group in 2015 (3). In order to define adherence to the multiapproach model the authors performed an informal expert consensus to propose a method to measure adherence to the model. The authors proposed three levels of adherence. We proposed three levels of adherence as follows: <b>High adherence:</b> For rheumatology patients had to attend between 6 and 12 consultations in one year. For physical therapy, physiatry, psychology, occupational therapy and nutrition patients had to attend to 3 or more consultations during one year per each specialty. <b>Moderate adherence:</b> For rheumatology patients had to attend between 3 and 5 consultations in one year. For physical therapy, physiatry, psychology, occupational therapy and nutrition patients had to attend between 2 or 4 consultations during one year per each specialty. <b>Low adherence:</b> For rheumatology patients had to attend between 1 and 2 consultations. For physical therapy, physiatry, psychology, occupational therapy and nutrition patients achieved only 1 consultation or less during one year per each specialty. We performed a descriptive analysis and compared the level of adherence and disease activity. <h3>Results</h3> During 2018 we reviewed the medical charts of 6851 patients diagnosed with rheumatoid arthritis; 82% were female and 18% were male. Mean age was 59 years 13 years old. Regarding disease activity mean DAS28 was 2.69 0.84. Most of patients that were considered as Moderate or High adherent achieve remission or LDA. See table 1. Levels of Adherence in Patients with RA <h3>Conclusion</h3> This is an initial approach in order to evaluate patients adherence and attendance to a new implemented multidisciplinary disease management model of attention for patients with RA in Colombia. Our descriptive study demonstrated that patients with moderate or high adherence can achieve better clinical outcomes compared to those who arent adherent to the model. <h3>Disclosure of Interests</h3> Laura Villarreal: None declared, Fernando Rodriguez: None declared, Michael Cabrera: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB