AB1603-HPR IMPACT ON PATIENT OUTCOMES OF SPONDYLOARTHRITIS MULTIDISCIPLINARY TEAM MEETINGS
Authors: T. Sardesai, S. Sayers, Q. Shah, D. Jadon
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> Multidisciplinary team (MDT) meetings are considered a component of gold-standard care for patients with spondyloarthritis (SpA) and concomitant psoriasis (PsO) or inflammatory bowel disease (IBD). There are few published reports on the impact of these multidisciplinary team (MDT) meetings on patients and clinicians. However, as attendance requires time away from clinical activities, evidence confirming benefit should be available. <h3>Objectives:</h3> To evaluate PsO-SpA and IBD-SpA MDT discussion utilisation by rheumatologists, dermatologists and gastroenterologists and the impact of meetings on patients and clinicians in a large university hospital. <h3>Methods:</h3> A single-centre, retrospective, observational analysis of electronic case-notes using a structured data-collection sheet to evaluate all patient discussions at PsO-SpA and IBD-SpA MDT meetings from 2016-2022. To improve impartiality, data were collected by two medical students (SS and TS), with clinical mentorship from a senior rheumatology fellow (QS) who was not involved in the MDTs. <h3>Results:</h3> PsO-SpA and IBD-SpA MDT meetings were evaluated. Each were attended by consultants, specialty registrars, fellows, clinical nurse specialists, research nurses and a biologics pharmacist. A total of 447 case discussions occurred (221 PsO-SpA, 226 IBD-SpA), comprising 308 unique patients (145 PsO-SpA, 163 IBD-SpA). A maximum of 8 discussions were held for each patient. 60% of cases discussed female patients, with a mean age of 49. Of the 421 case discussions for which smoking data was available, 57% discussed past or present smokers. Comorbidities included obesity (42%), hypertension (26%), depression (22%), chronic pain (14%), NAFLD (14%) and dyslipidaemia (13%). Of the discussions for which the referring specialty was specified, 58% were referred by rheumatologists, 27% by dermatologists and 14% by gastroenterologists. The reason for referring patients to the MDT were non-mutually-exclusive: therapeutic query (66%), requesting a clinical consult (15%) and seeking general advice (19%) (Figure 1A). 9 overlapping, MDT-specific outcomes were assessed for each case (Figure 1B). 63% of discussions resulted in a change to patient management, 44% facilitated timely investigations or consults to clarify the diagnosis or optimise patient care, and 7% recruited patients to a clinical trial or enabled drugs to be prescribed to patients that were not yet licenced for the other speciality, thereby improving the treatment options available in the management of complex cases. In addition, 35% improved patient safety by avoiding concurrent use of multiple immunosuppressive therapies, 33% avoided unnecessary referrals and 17% reduced high-cost drug use, thereby improving cost- and time-efficiency. Furthermore, 98% of meetings were deemed to contribute to clinician education and 96% improved communication between clinical teams. These results were largely similar for each MDT meeting. Differences involved the number of inter-specialty referrals (10% for PsO-SpA meetings, 55% for IBD-SpA meetings) and the potential reduction of high-cost drug use (11% for PsO-SpA meetings, 23% for IBD-SpA meetings). MDT discussions' impact on DMARD prescriptions were analysed and revealed a transition towards advanced therapies (Figure 1C). The proportion of cases treated with conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) decreased from 46% at the time of the MDT meetings to 41% after 12 months and the proportion treated with biologic or targeted synthetic DMARDs increased from 58% to 78%. <h3>Conclusion:</h3> MDT meetings between rheumatologists, dermatologists and gastroenterologists have been beneficial for patients, clinicians and institutions. They have been observed to be associated with increased utilisation of advanced therapies. This approach might be considered by other rheumatology, dermatology and gastroenterology departments. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> Our thoughts are with Dr Jadon's family after his tragic passing. These meetings and their evaluation would not have been possible without his work and mentorship. <h3>Disclosure of Interests:</h3> Thomas Sardesai: None declared, Sarah Sayers: None declared, Qutab Shah: None declared, Deepak Jadon D.J. declared that he had received research grants, education grants and/or honoraria from pharmaceutical companies, including: AbbVie, Amgen, Biogen, Celgene, Eli Lilly, Fresenius Kabi, Galapagos/ Gilead, GSK, Healthcare Celltrion, Janssen, Merck, Novartis, Pfizer, Roche, Sandoz and UCB.