OP0157-HPR DISSEMINATION AND ASSESSING IMPLEMENTATION OF THE EULAR RECOMMENDATIONS FOR PATIENT EDUCATION FOR PEOPLE WITH INFLAMMATORY ARTHRITIS ACROSS EUROPE
Authors: S. Bennett, H. A. Zangi, A. Van Tubergen, M. Ndosi
Journal: Annals of the Rheumatic Diseases (2020)

Background: EULAR recommendations for patient education for people with inflammatory arthritis (IA) were published in 2015. 1 This is the first systematic dissemination and implementation study, reporting qualitative data identifying barriers to implementation of the recommendations. Objectives: To (i) disseminate and assess the level of acceptability and applicability of the EULAR recommendations for patient education among healthcare professionals and rheumatologists and (ii) assess potential barriers and facilitators to their application in clinical practice. Methods: This was a cross-sectional study using survey methods. Survey items were developed in English and translated into 20 different languages before being distributed to health professionals by snowball sampling using an online platform. The items covered demographic information and 10-point rating scales assessing the level of acceptability and applicability of each of the eight recommendations. In addition, textual data fields were provided to assess reasons for disagreeing and barriers to implementation of the recommendations in practice. Quantitative data were analysed descriptively with agreement and applicability levels summarised as median (IQR) scores. Textual data were analysed by content analysis and presented in themes. Finally, collaborators in each country reviewed the top barriers to implementation and proposed facilitators to implementation in their respective countries. Results: A total of 2442 responses were recorded from 23 countries, but only 1495 contained complete data. Of complete responses, 74% were women. Most of the professionals were nurses (n=640), rheumatologists (n=369) and physiotherapists (n=232). Table 1 presents the levels of agreement and applicability of the recommendations. For all recommendations, the level of agreement was high (median=10). However, the level of applicability was generally lower compared to each corresponding agreement level, especially for recommendation 6, which states that the effectiveness of patient education should be evaluated. Lack of an effective evaluation tool was the biggest barrier to implementation. Table 1. Levels of agreement and applicability of each recommendation. Agreement Applicability Median IQR Median IQR Recommendation 1 10 10 to 10 8 7 to 10 Recommendation 2 10 10 to 10 8 6 to 10 Recommendation 3 10 9 to 10 8 7 to 10 Recommendation 4 10 8 to 10 7 5 to 10 Recommendation 5 10 8 to 10 7 5 to 9 Recommendation 6 10 8 to 10 6 4 to 8 Recommendation 7 10 9 to 10 8 5 to 8 Recommendation 8 10 10 to 10 8 5 to 8 There were notable similarities between barriers and facilitators for implementation of the recommendations across countries. The 3 most common barriers to application were; (i) lack of time (ii) lack of training in how to provide patient education and (iii) not having enough staff to provide patient education. The most common facilitators were: tailoring the content and delivery of patient education to individual patients; training providers, and evaluating the effectiveness of patient education with individual patients. Conclusion: This project has disseminated the EULAR recommendations for patient education across 23 countries. There was high agreement with the recommendations among health professionals but their application to clinical practice was lower. Some barriers to application are amenable to change such as addressing training needs of health professionals and developing evaluation tools for patient education. Figure 1. Recommendations for patient education in inflammatory arthritis. 1 References: [1]Zangi HA, et al. EULAR recommendations for patient education for people with inflammatory arthritis Ann Rheum Dis . 2015; 74 :954-962. Disclosure of Interests: Sarah Bennett: None declared, Heidi A. Zangi: None declared, Astrid van Tubergen Consultant of: Novartis, Mwidimi Ndosi Grant/research support from: Bristol Myers Squibb, Consultant of: Janssen, Pfizer