FRI0648-HPR OUTPATIENT FOLLOW-UP ON DEMAND IN RHEUMATOID ARTHRITIS HAS SAME CLINICAL AND RADIOGRAPHIC OUTCOMES BUT FEWER VISITS THAN SCHEDULED ROUTINE CARE
Authors: R. P. Poggenborg, O. Rintek Madsen, L. Dreyer, A. Hansen
Journal: Annals of the Rheumatic Diseases (2020)

Background: Medical treatment and care are often life-long in patients with rheumatoid arthritis (RA). During periods of stable disease, patients typically attend routine visits every 3–8 months at the rheumatology outpatient clinic. Between scheduled medical visits, it may be difficult to get acute appointments with the rheumatologist. Scheduled routine visits may be in a stable period without any symptoms and with no need for control and adjustment of treatment. Consequently, there is a demand for developing outpatient control procedures that cater to the needs of the individual patient and which support the patient‘s experience of active participation in the control and treatment of their own disease. Objectives: To compare a patient self-controlled outpatient follow up system (Open Outpatient Clinic System (OOCS)) with traditional scheduled routine visits at a rheumatology outpatient clinic. Methods: A two-year randomised controlled trial with RA patients aged 18 to 80 years with a disease duration of at least one year. Patients were recruited consecutively from the rheumatology outpatient clinic of a major university hospital in the Copenhagen region of Denmark from February 2015 to January 2017. Patients were randomised electronically. Joints were examined by a blinded rheumatologist. Patients in the OOCS group had no scheduled appointments but were allowed to book acute appointments with their contact rheumatologist within 5 days and had access to nurse-led consultations without pre-booking, and a nurse-led telephone helpline. Appointments for the control group were scheduled according to routine procedures. Outcome measures were collected at baseline, year 1 and year 2. Clinical parameters: DAS28, CRP, VAS pain, 28-tender and swollen joint count (28-TJC and 28-SJC), HAQ score and radiographs of hands and feet. Psychological parameters: VAS patient satisfaction (Pt satisfact) and quality of life (EQ-5D). Results: Of 282 patients, 266 completed the first year, 239 the second year. Patient characteristics (OOCS/controls): age 61.4±10.5/60.9±12.2 years, females 77/74%, ACPA positive 66/65%, treatment with synthetic DMARDs 67/65% and/or biologics 33/35%. Clinical and psychological parameters are shown in Table 1. OOCS at year one and two was comparable to traditional scheduled routine procedures regarding clinical and psychological outcome measures. Radiographic progression was detected in 2.9% (4/138) and 2.1% (3/140) of the OOCS and control group, respectively (p=0.69; Chi-squared test). Table 1. Outcome measures in patients with RA randomised to on demand Open Outpatient Clinic System (OOCS) or traditional follow-up (control group) in a rheumatology out-patient clinic. Results are shown as mean±SD. OOCS Controls OOCS Controls OOCS Controls Time Baseline Baseline Year 1 Year 1 Year 2 Year 2 Visits 3.2±1.9 3.8±1.6* 2.6±1.6 3.5±2.2** Phone calls 1.8±3.3 0.4±0.8** 0.7±1.4 0.1±0.3** DAS28 3.0±1.2 2.9±1.0 2.6±1.1 2.6±1.0 2.7±1.2 2.5±1.0 CRP 10.2±7.2 10.1±8.0 8.2±9.9 5.7±5.1* 9.6±8.8 5.5±8.9* 28-SJC 0.6±1.5 0.6±1.2 0.2±0.5 0.3±1.0 0.3±0.9 0.4±1.2 28-TJC 3.3±5.7 2.4±4.2 2.4±4.7 2.1±3.7 2.4±4.9 2.3±4.7 VAS pain 27±25 26±21 28±26 28±24 32±27 29±25 HAQ-score 0.6±0.6 0.6±0.6 0.7±0.6 0.6±0.6 0.8±0.7 0.6±0.7 EQ-5D 0.8±0.2 0.8±0.1 0.8±0.2 0.8±0.2 0.8±0.2 0.8±0.1 Pt satisfact 88±21 87±19 84±25 82±23 82±24 83±23 *p&lt;0.05; **p&lt;0.0005, OOCS vs. control group (Student’s t-test). Conclusion: The patient self-controlled outpatient follow up system OOCS was associated with fewer visits, but more phone calls to the nurse, and was comparable with traditional scheduled routine procedures regarding clinical, psychological and radiographic outcomes after two years. Thus, organisation of outpatient care according to OOCS may be applied to strengthen patient-centred care in patients with RA. Disclosure of Interests: René Panduro Poggenborg Speakers bureau: Novartis, Ole Rintek Madsen: None declared, Lene Dreyer: None declared, Annette Hansen Consultant of: AbbVie, Speakers bureau: Eli Lily