AB0808 IMPLEMENTING IPad-BASED ASSESSMENTS TO IMPROVE PERFORMANCE IN A PSORIATIC ARTHRITIS CLINIC AT A DISTRICT GENERAL HOSPITAL
Authors: S. Mukherjee, B. Quilty, H. Burstow, K. Hennessy
Journal: Annals of the Rheumatic Diseases (2020)

Background: Psoriatic Arthritis (PsA) is a complex disease with profound physical and psychosocial effects. The core domain set for this condition was updated by the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA)-Outcome Measures in Rheumatology (OMERACT) PsA working group in 2016 1 and the TICOPA (TIght COntrol of Psoriatic Arthritis) study suggested that adopting a ‘treat-to-target’ approach aiming for Minimal Disease Activity (MDA) could result in better clinical outcomes 2 . Objectives: To improve assessment of all the core domains of PsA during clinic appointments and aim to treat these patients using a ‘treat-to-target’ approach to improve clinical outcomes. Methods: We were able to confirm through a retrospective baseline audit that all core domains of PsA were not being fully addressed in our general rheumatology clinics. A dedicated weekly PsA clinic was then set up at our district general hospital. Subsequently, iPads incorporated with GRAPPA App were implemented in these clinics to facilitate multi-domain assessments aiming for MDA. This was supported by a Health Education England (Wessex) Quality Improvement Fellowship that involved rheumatology and dermatology team members working in close collaboration. We then carried out a re-audit to assess our performance. Additionally we set up quarterly combined Rheumatology and Dermatology clinics for patients with severe joint and skin involvement. We also conducted a baseline survey by asking patients for their opinion about the ‘setting up of the dedicated PsA service’, the ‘quarterly combined clinics’ and the ‘use of iPad-based assessments’. We asked them to score each of these on a scale of 0 to 10, with 0 being ‘very negative’ and 10 ‘very positive’. Results: We had pragmatically set a standard of 75% for our baseline audit but we found an overall compliance of only 27.4%. There was also a wide variation between different domains with a compliance of even 0% for some. Domains that are not assessed are unlikely to be fully taken into account when deciding about treatment. The re-audit following the implementation of iPad-based assessments in dedicated PsA clinics showed a significant improvement in each of the domains and the overall compliance went up to 97.9% (Table 1). The patient survey findings were also excellent with mean scores of 9.5, 9.0 and 9.5 respectively for the three items (Figure 1). Table. 1 Audit (n = 25 ) Re-audit (n = 29 ) Compliance Q1. Documented evidence of joint count being performed? 84.0% 100.0% Q2. If yes, then was it a 66/68 count for swollen and tender joints? 4.7% 100.0% Q3. Documented evidence of dactylitis being assessed? 8.0% 100.0% Q4. Documented evidence of enthesitis being assessed? 4.0% 100% Q5. Documented evidence of assessment of spinal involvement? 8.0% 100.0% Q6. Documented evidence of assessment of skin involvement? 36.0% 100.0% Q7. Documented evidence of assessment of nail involvement? 4.0% 93.1% Q8. Documented evidence of assessment of fatigue? 8.0% 96.6% Q9. Documented evidence of assessment of degree of pain? 60.0% 100.0% Q10. Documented evidence of patient’s global assessment? 68.0% 96.6% Q11. Documented evidence of assessment of physical function? 0.0% 96.6% Q12. Documented evidence of assessment of health-related quality of life? 0.0% 93.1% Q13. Documented evidence of assessment of systemic inflammation? 72.0% 96.6% Overall Compliance 27.4% 97.9% Conclusion: Dedicated PsA clinics using the GRAPPA App on iPads could facilitate comprehensive multi-domain assessments of patients with PsA and potentially lead to better outcomes as well as greater patient satisfaction. References: [1]Orbai AM et al ., (2017) Updating the psoriatic arthritis (PsA) core domain set: a report from the PsA workshop at OMERACT 2016. J Rheumatol 44(10):1522–1528 [2]Coates LC et al ., Effect of tight control of inflammation in early psoriatic arthritis (TICOPA): a UK multicentre, open-label, randomised controlled trial. Lancet. 2015; 386(10012):2489–2498 Acknowledgments Disclosure of Interests: None declared