FRI0652-HPR DEVELOPMENT OF THE ADVANCED PRACTICE NURSING CONSULT IN RHEUMATOLOGY IN THE MULTIDISCIPLINARY APPROACH OF INFLAMMATORY DISEASES MEDIATED BY IMMUNITY
Authors: A. Lopez Esteban, P. Morales de Los Ríos Luna, P. Villalpando G, A. López Calleja, T. Del Río Blasco, B. Villarrubia Martín, S. Sánchez Vázquez, C. Lobo Rodríguez
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patients with immunity mediated inflammatory diseases (IMID) often have clinical manifestations and comorbidity in the field of various medical specialties. A center has been created in our hospital for the comprehensive care of patients with IMID. It is an innovative healthcare model, that incorporate patients into its governance. Physicians, pharmacists and advanced practice nurses (APN), collaborates in consultation or in the day hospital (DH). Objectives: To analyze the activity of the rheumatology APN consult integrated in the multidisciplinary team, and the impact on health care and quality of life on IMID patients. Methods: Descriptive study of the rheumatology APN activity since the opening of the center for a year. The APN consultations were face-to-face (scheduled or demanded) or by telephone. Variables measured: demography, diagnosis, treatments, clinic activity and patient reported outcomes (PRO). In the face-to-face consultation, was included: integral valuation (clinic, functional and psychosocial), education for Health (information about disease and treatments, adverse effects, healthy living habits), drug administration, emotional support. In the telephone consultation, the rheumatology APN is the reference professional for monitoring, question solving and advice in case of flare or adverse event. Results: 721 patients were evaluated, mean age 54.6 years, (range, SD) (20-90, 13.9), 61.3% women, with a total of 1737 consults. Diagnosis: 324 (44.9%) RA, 221 (30.6%) SpA, 100 (13.9%) PsA and 76 (10.5%) other diseases. Treatment modality: IV 293 (40.4) SC 399 (55.3%) and oral 29 (4.0%). Rheumatology APN activities are described in Table 1. 1415 face-to-face consultation were made, 82.7% scheduled and 17.2% demanded either by the patient, the rheumatologist or another member of the multidisciplinary work-team. Among the face-to-face consultations, 62 (4.4%) patients were attended the same day in the medic consult due to disease flare or other disease problems, 38 (2.7%) patients were sent to another specialist of the work-team due to co-morbidity. The activity executed in the rheumatology APN consultation is shown in Table 2 Table 1. Educative interventions by the APN. •Information about the disease •Information about the treatment •Medicine administration •Adverse effects of the medicine •Healthy life style habits •Vaccines •Evaluation of cardiovascular risk •Signs and symptoms of alerts due to the pathology •Ongoing following of the evolution of the disease. •Support for the achievement of the treatment and possible difficulties. Table 2. Activity done in the consult. N° 1.737 Face-to-face activity N° consults 1.415 Non face-to-face activity N° consults 322 Complete valuation due to necessities 721 (51%) Valuation 58 (18.0%) Educative Interventions 1.305 (92.2%) Questions 96 (29.8%) Valuation and following 1.372 (97.0%) Test result 26 (8.1%) PRO execution 1.156 (81.7%) Articular counting’s 733 (51.8%) Valuation of the diseases activity •DAS28 PCR •ASDAS-PCR 737 (52.1%) 419 (26.6%) Process of appointment •Requested by the doctor •Requested by the patient. 105 (32.61 50 (47.0%) 55(53.0%) Cardiovascular risk valuation. 721 (51.0%) Derivative to different medical consults 37 (11.5%) Blood extraction 724 (51.2%) Solved by APN 285(88.5%) Analytics monetarization 1.171 (82.8%) Medicine monetarization 1.372 (97.0%) Day Hospital Management Conclusion: The rheumatology APN takes a vital part in the multidisciplinary team, offering a holistic approach, as well as efficient and high-quality care, offering quick response, reducing waiting time and becoming an important part of this patient-centered model. Disclosure of Interests: None declared