POS0060-PARE RHEUMATOID ARTHRITIS IN NORWAY: A SURVEY-BASED PATIENT EXPERIENCE
Authors: C. P. Fjellstad, M. Hägg, M. Kautonen, R. Mandla
Journal: Annals of the Rheumatic Diseases (2021)

Background: The Norwegian Association of Rheumatologists has established a national procedure for management of rheumatoid arthritis (RA) in Norway. 1 The purpose of the procedure is to support equal and evidence-based diagnosis, care and follow-up of RA patients 1 . It serves as guidance to all responsible of RA patient health care. The procedure includes recognized themes in rheumatic care. 2,3 The impact of the procedure on RA care in Norway is, however, unknown. Objectives: To understand the patient experience through evaluating how the national procedure for RA is being followed from the patient viewpoint. To identify gaps and areas of improvement to align the national procedure and patient experience. Methods: Members of patient organization Norwegian Rheumatism Association were invited to answer a survey on demographic and disease-specific variables, perceived health and quality of care. The survey was supported by service design patient interviews (N=14). The invitations for interviews were sent through many initiatives for a representable population. Results: The observational RA cohort constituted of N=374. The patients were on average satisfied with shared decision-making, care and follow-ups: 71 % felt their illness was under control. Patients in centralized areas were more satisfied with well-being. Diagnosis times have shortened from on average 1.7 to 1.5 year in 10 years. Patients, especially those working, were dissatisfied with rehab support. 30 % of patients felt cooperation of primary and secondary care was not satisfactory and 32 % were worried for future treatment. Table 1 shows the differences in awareness of comorbidities and regular vaccination need. Where applicable, the table also shows the percentage of patients screened. The results show that patients are aware of risks, but are not being screened for the conditions. Younger patients (&lt; 50 years) with symptoms for less than five years were generally less aware. Table 1. Awareness of comorbidity and regular vaccination need Comorbidities Regular vaccine need Heart disease Lung disease Osteoporosis Awareness Screened Awareness Screened Awareness Screened Awareness Overall (# of patients) 70 % (239/342) 34 % (115/342) 37 % (127/342) 25 % (87/342) 58 % (201/344) 41 % (141/343) 56 % (191/344) Age Under 50 yrs 67 % (42/63) 24 % (15/63) 39 % (24/62) 27 % (17/63) 46 % (29/63) 19 % (12/63) 51 % (32/63) Over 50 yrs 71 % (197/279) 36 % (100/279) 37 % (103/280) 25 % (70/279) 61 % (172/281) 46 % (129/280) 57 % (159/281) Disease onset Under 5 yrs 56 % (27/48) 19 % (9/48) 29 % (14/48) 20 % (10/49) 51 % (25/49) 21 % (10/48) 59 % (29/49) Over 5 yrs 72 % (212/294) 36 % (106/294) 38 % (113/294) 26 % (77/293) 59 % (176/295) 44 % (131/295) 55 % (162/295) The education of patients about regular vaccines (e.g. influenza and pneumonia) could be improved. Only 56 % were aware of the need for these vaccines due to RA. When asked specifically, 73 % of patients had received an influenza vaccine and 48 % pneumonia vaccine. Conclusion: This survey examines quality of care, shared decision-making, disease awareness and planning and provides a gap analysis of patient experience and national procedure. The results show that national procedure in RA is being followed from the patient viewpoint. Patients are satisfied with care, but information on preventive care (e.g. vaccination and comorbidity awareness and screenings) could be strengthened. This could improve planning of care and the outlook, particularly for young patients. References: [1]Aga AB, Haavardsholm EA. Revmatoid artritt. Nasjonal veileder i revmatologi. 2020 [2]Barber CEH, Lacaille D, Hall M, Bohm V, Li LC, Barnabe C, Hazlewood GS, Marshall DA, Rankin JA, Tsui K, English K, MacMullan P, Homik J, Mosher D, Then KL. Priorities for High Quality Care in Rheumatoid Arthritis: Results of Patient, Health Professional, and Policymaker Perspectives. J Rheumatol. 2020 [3]Brekke M, Hjortdahl P, Kvien TK. Involvement and satisfaction: a Norwegian study of health care among 1,024 patients with rheumatoid arthritis and 1,509 patients with chronic noninflammatory musculoskeletal pain. Arthritis Rheum. 2001 Feb;45(1):8- Disclosure of Interests: Christian Pollock Fjellstad: None declared, Milla Hägg Consultant of: Pfizer, Moona Kautonen Consultant of: Pfizer, Randeep Mandla Shareholder of: Pfizer, Consultant of: Pfizer, Employee of: Pfizer.