AB0958 HOW ARE PATIENT REPORTED OUTCOME MEASUREMENTS USED IN AXIAL SPONDYLOARTHRITIS? A QUALITATIVE STUDY WITH HEALTH CARE PROFESSIONALS AND PATIENTS
Authors: X. Juanola-Roura, V. Navarro-Compán, A. Moltó, T. Oton, L. Carmona
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The ASAS-EULAR recommendations to manage patients with axial spondyloarthritis (axSpA) strongly recommend using patient-reported outcome measures (PROMs) to monitor disease activity and impact. However, their use in clinical practice is far from widespread, even among expert groups. <h3>Objectives:</h3> To investigate the barriers and facilitators for using PROMs in the care of patients with axSpA. <h3>Methods:</h3> As part of a broader project on the implementation of questionnaires in asSpA, we conducted a qualitative study by interviewing health care professionals with varying experience in axSpA and patients with axSpA. The interviews were conducted via videoconference, lasting approximately 45 minutes. An interview guide included questions on the experience and use, the barriers to its use, and understanding of the PROMs. Specifically, the following questionnaires (in Spanish) were evaluated: the Bath Ankylosing Spondylitis Activity Index (BASDAI); Ankylosing Spondylitis Disease Activity Score (ASDAS); the Bath Ankylosing Spondylitis Functional Index (BASFI); the ASAS Health Index (ASAS-HI) and the Numerical Scale (NRS) for Patient Global Disease Activity (0 to 10). <h3>Results:</h3> 15 interviews were conducted (7 with patients and 8 with professionals). Tables 1 and 2 describe demographic characteristics of both groups. All the professionals interviewed were familiar with the different questionnaires, although not all used them regularly. The most established in clinical practice were BASDAI and BASFI, followed by ASDAS. Only one professional (Prof4) acknowledged using the ASAS-HI in her regular practice routine. Professionals in private practice (Prof2 and Prof7) showed a much more irregular administration; they tried to collect them as a control guide once or twice per year, especially in patients with more severe disease. When asked about the reasons for not using them regularly, they commented, "<i>The way the consultations are organised, with no nurses, only administrative staff, no thematic (monographic) units, and we don't know in advance who is coming. In addition, we are under much pressure to provide care, and the management programmes are prolonged and cumbersome</i>". The reason most often mentioned by the professionals that could limit their use was the limited time in the consultation room. The patients were familiar with the questionnaires, especially the BASDAI and the patient global Numerical Rating Scale (NRS) and, to a lesser extent, the BASFI. They doubted whether they had filled the ASAS-HI, but most could not remember doing so. Some patients completed the PROMs frequently, mostly on paper. They reported that, in general, they do not know how the questionnaires are scored or what the score means, and in general, they do not know what PROMs are used for (several answered "<i>for a study</i>"). They expressed interest in knowing what they were for and the results. <h3>Conclusion:</h3> The PROMs are not implemented as they should mainly because of lack of time and perceived need for additional staff. People with axSpA would appreciate adequate information for their completion. Resistance to complete the questionnaires could be tackled with best practice examples on how to do it efficiently. We will use this information to suggest strategies for better implementation. <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>