BackgroundRheumatoid arthritis (RA) is a chronic, disease that affects more than 1% of global population, it is a long term condition that causes pain and disability. Evidence had shown that most of the patients are moderately disabled, which brings the necessity of a caregiver to become the patients companion due to its chronic disease. The caregiving role can have an impact in the psychological and physical spheres of the caregivers life.ObjectivesThe aim of this study was to explore demographical characteristics and caregiver burden through the Zarit Scale.MethodsWe conducted a cross sectional study in a meeting where caregivers in a rheumatoid arthritis specialized setting. We collected sociodemographic information, and applied the Zarit caregiver burden interview (ZBI) adapted to Spanish. The ZBI includes 22 questions which has 5 responses from 0 (never) to 4 (nearly always), where scores lower than 47 indicated little to no burden, 47 to 55 low burden and >55 intense burden. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates.ResultsWe applied a survey to 132 caregivers. Mean age was 52 years SD 19 and 72% were women, 78% of them were taking care of a patient with rheumatoid arthritis, 12% osteoarthrosis 2% lupus, 2% osteoporosis the remaining 6% were caregivers of patients with ankylosing spondylitis, fibromyalgia, Sjogren syndrome. Regarding the time as caregiver 48% of them had been carrying the task for less than a year, 16% between two and three years, 18% for more than three years, and 13% for more than four years 5% of them were temporarily caregivers. In our study 85% of caregivers were a family member while15% was a nurse or a non-related person. Zarit mean score was 38.2913, additionally 35% had a score higher than 41 points. See table 1.Abstract AB1395HPR Table 1 Zarit scale classificationVariablen%Zarit Score0-21 (little or no burden)96.3422 - 40 mild to moderate burden8257.7541 - 60 moderate to severe burden4330.2861-88 severe burden85.63ConclusionIn our study 93% of our patients reported to have moderate to severe burden; thus, it is important to develop strategies and explore the factors related to burden in caregivers in patient with rheumatoid arthritis.Disclosure of Interests:Diana Buitrago-Garcia: None declared, Laura Villarreal: None declared, Michael Cabrera: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Fernando Rodriguez: None declared
BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory autoimmune disease of unknown etiology, it is a long term condition that causes pain, disability and affects the quality of life (1). In another countries has been demonstrated how patient education can empower the individual giving as a result a better decision making between the practitioner and patient in order to obtain better health care outcomes compared to patients that are not involved in educational activities (1).ObjectivesThe objective of this work is to show how through a progressive program of patient education we reach the concept of the “expert patient” and the “patients' university”.MethodsWe performed a systematic review of the literature in global and regional databases (Pubmed, Medline, Scopus, Lilacs), in order to search for information on this research question-hypothesis. Subsequently and under a Delphi-modified methodology and consensus of experts lay the conceptual bases on this particular subject – patient's education in rheumatic disease. As a result of the above was defined a proposal for the constitution and development of the program of patient's education in a RA specialized center under the concept of the “expert patient” (EP) and the “patients' university”(PU).ResultsFrom conceptual point of view specific themes regarding patient's education were developed by a coordinator who, after a review of the literature, presented a specific proposal on the particular topic that was discussed with the panel members and then voted on and finally implemented within the EP y PU concepts. In a specialized RA center in Bogotá Colombia during 2016 we started a patient and caregiver oriented program to support the clinical treatment in patients with RA. The structure of the program was an educational-recreational strategy where we integrated health education (disease activity, pharmacovigilance, psychology and nutrition) and recreational activities such as crafts, yoga, aerobics and dance lessons with a periodicity of two times per week. We called the program “Gest-Art”. As a result of this pilot program we obtained a positive impact and perception among patients and care takers; we had the participation of 600 people during the whole year. The next phase is to develop a step-by-step program to initially train and then specialize patient focus groups (expert patient); and later develop a model of continuous improvement (updating) that we will call the university of patients.ConclusionsFrom this experience we can conclude that the implementation of this educational program opened the opportunity to empower and motivate our patients and caregivers to be actively participative with the disease management and health care, also the program has been a space for the patients to share their experiences and to propose new strategies to improve the program.References Prothero L, Georgopoulou S, de Souza S. Patient involvement in the development of a handbook for moderate rheumatoid arthritis. 2016. Disclosure of InterestNone declared
BackgroundAccording to the Beryl Institute's, patient experience (PX) is “the sum of all interactions, shaped by an organization's culture, that influence patient perceptions, across the continuum of care”; nowadays patient satisfaction is considered as one of the quality for performance in health systems (1). In order to provide a multidisciplinary quality care to patients with RA in centers of excellence (CoEs) under the coordination of a rheumatologist, provide comprehensive management of patients with this pathology, ensuring approachability to medical appointments and treatment, in order to get better clinical outcomes and improve patient safety and satisfaction of the health services provided.ObjectivesTo measure levels of satisfaction of RA patients treated at a specialized center and to evaluate patient service.MethodsIn a RA specialized center during a 24 month period we performed a satisfaction survey in order to evaluate the health services provided. We evaluated the timing on attention, appointment assignment, information provided, the treatment received by the healthcare team, facilities among others. Patients evaluated the services provided in a scale from 1 to 4, were 1 was very bad, 2 regular, 3 good and 4 excellent. Descriptive epidemiology was performed for each variable presented.ResultsWe collected 1125 surveys during 2015 and 2016, 45% considered to have a timely care, the mean of waiting time for an appointment was 9 min ± 8; regarding the appointment assignment 96% of the patients evaluated it as good or excellent (mean 3.5±0.7), 80% considered that the information provided was clear and useful, 90% reported to receive a kind and friendly treatment and to considered the facilities as good or excellent. When we evaluated the satisfaction regarding the health care team 50% of patients evaluated the rheumatologist, nurse, nutritionist, physical therapist, psychologist and physiatrist as good and 40% as excellent.ConclusionsAlthough we found that our patients are highly satisfied, there is a large opportunity to improve our services. Also, this evidence can support further research projects in order to increase the patient's satisfaction.References Th VP. Creating the ideal patient experience. Journal of medicine and life. 2016;9(4):380–385. Disclosure of InterestNone declared
BackgroundPain is often disabling and can reduce the quality of life of a patient. Pain medications are drugs commonly prescribed for a variety of conditions one of them rheumatoid arthritis. The common molecules prescribed are paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), and opioids.ObjectivesThe goal of this study was to analyze the prevalence of pain medication prescription in patients with Rheumatoid Arthritis in a specialized center in Colombia.MethodsWe collected data from the medical charts in a specialized RA center conducted during 5 years, we performed a descriptive analysis, we collected sociodemographic information, DAS28, and the prevalence of prescription of analgesic medications divided in three groups non-opioid analgesics, opioid analgesics and NSAIDS. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We evaluated the relationship between DAS28 and the usage of pain medications.ResultsWe reviewed the medical charts of 7076 patients diagnosed with rheumatoid arthritis, 82% were female and 17% were male. Median age was 60 years RIQ (51-69). The prevalence of usage of pain medications was 45%. Most of patients received paracetamol followed by a combination of paracetamol. See table 1. The prevalence of pain medications usage was not with associated disease activity.Pain medication n % Paracetamol240734Paracetamol + opioids74411NSAID631ConclusionAs other studies have shown the prevalence of pain medications in patients with RA is high. The most prescribed medication was paracetamol or opioids, coinciding with other studies (1). This descriptive study is useful for further studies to develop in Colombia and Latin America. Additionally, it is important to consider other alternative therapies in order to approach in painful condition like RA.Disclosure of Interests Wilberto Rivero: None declared, Diana Buitrago-Garcia: None declared, Pedro Santos-Moreno Grant/research support from: Dr Santos has received research grants from Janssen, Abbvie and UCB, Speakers bureau: Dr Santos has received speaker fees from Sanofi, Lilly, Bristol, Pfizer, Abbvie, Janssen and UCB, Fernando Rodriguez: None declared
BackgroundRheumatoid arthritis (RA) is a chronic, inflammatory disease of the joints affecting more than 1% of global population, it is a long term condition that causes pain and disability.1 Evidence had shown that most of the patients are moderately disabled, and about 10% of the patients suffered from severe disablement which brings the necessity of a caregiver to become the patient’s companion due to its chronic disease.2 The caregiving role can have an impact in the psychological and physical spheres of the caregiver’s life.3 ObjectivesThe aim of this study was to explore demographical characteristics and caregiver burden through the Zarit Scale.MethodsWe conducted a cross sectional study in a meeting where caregivers in a rheumatoid arthritis specialised setting. We collected sociodemographic information, and applied the Zarit caregiver burden interview (ZBI) adapted to Spanish. The ZBI includes 22 questions which has 5 responses from 0 (never) to 4 (nearly always), where scores lower than 47 indicated little to no burden, 47 to 55 low burden and >55 intense burden. We calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We categorised age of caregivers and compared to it to ZBI score, we used X2 to perform bivariate analysis.Results115 caregivers were included in the study, 63% were female and 37% were male. Mean age was 49 years±18 and 35% were single. Regarding educational level 44% had college degree, most of caregivers 30% had a full time job, and also 45% had other family members as their responsibility. See table 1. Zarit mean score was 44±14, additionally 71% had a score lower than 47. See table 1. Regarding age groups 35% of patients were older than 60 years and 15% of them were considered with intense burden disease, there was no statistical association between age and disease burden, see table 2.Abstract AB1451HPR – Table 1Zarit scoreZarit Score <47827147–551412>551917Abstract AB1451HPR – Table 2Zarit scale classification according to age groupsVariable15–39 years n=3640–60 years n=38Older than 60 years n=41P value No burden2028300.108Low burden8550.375Intense burden8560.436ConclusionsAlthough a high proportion of caregivers reported to have not burden, it is important to develop strategies and activities in order to attend the necessities of the caregivers in order to reduce the overload of responsibilities among them. Also further research is needed in order to identify the risk factors or protector factors that can prevent disease burden in caregivers.References Prothero L, Georgopoulou S, de Souza S. Patient involvement in the development of a handbook for moderate rheumatoid arthritis. 2016. Jacobi CE, van den Berg B, Boshuizen HC, Rupp I, Dinant HJ, van den Bos GA. Dimension-specific burden of caregiving among partners of rheumatoid arthritis patients. Rheumatology (Oxford, England). 2003;42(10):1226–33. Win KK, Chong MS, Ali N, Chan M, Lim WS. Burden among Family Caregivers of Dementia in the Oldest-Old: An Explorator...
BackgroundPatient experience (PX) can be conceptualised as “the sum of all interactions, shaped by an organisation’s culture, that influence patient perceptions, across the continuum of care” nowadays patient satisfaction is considered as one of the quality for performance in health systems(.1 Rheumatology is mainly an outpatient, multidisciplinary medical specialty, therefore care does not stop at the diagnosis it continues during a long-term with frequent monitoring and patient participation.2 ObjectivesDescribe the results of a patient satisfaction survey in a specialised centre in. Colombia during 2017MethodsIn our RA specialised centre during a 12 month period we performed a satisfaction survey in order to evaluate the health services provided. We evaluated the waiting times, timing on attention, appointment assignment, and information provided, the treatment received by the healthcare team, facilities among others. Patients evaluated the services provided in a scale from 1 to 5 were 1 was very bad, 2 bad, 3 regular 4 good and 5 very good. Descriptive epidemiology was performed for each variable presented.ResultsWe performed 4756 surveys during 2017, 4550 surveys were completed with a 95% rate response, out of total 80% of respondents were female and 20% male. 80% of patients reported to receive their appointments on time; regarding the service provided by our health care professionals 99% of patients understood the indications regarding their treatment, 98% understood about the administrative procedures to program future appointments and to how to access to their medications, also 98% had clearly understood the date and time of their consultation (rheumatologist, physical therapist, nutritionist, psychologist, infusion therapy, among others.) The mean score for the overall assessment of the services was 4.2/5.0 (table 1). The average time of stay at our centre was 60 min±33. The main aspects to improve our patient satisfaction were the telephone programming of appointments, and the compliance regarding the delivery of medications.Abstract AB1445-HPR – Table 1QuestionMEAN (SD)MEDIAN (MIN –MAX) How was the quality of the service provided?4.25 (0.51)4 (3–5)How was the service provided by our health care team?4.31 (0.49)4 (1–5)How was the service provided y in the waiting room?4.27 (0.49)4 (1–5)Facilities4.31 (0.49)4 (1–5)Overall experience4.32 (0.53)4 (3–5)ConclusionsThis survey describes well-functioning multidisciplinary services for all patients who visit to our specialised centre. On the other hand although we found that our patients are highly satisfied, there is a large opportunity to improve our services and generate evidence regarding other aspects that involve the patient’s health determinants.References Th VP. Creating the ideal patient experience. Journal of medicine and life. 2016;9(4):380–5. Vare P, Nikiphorou E, Hannonen P, Sokka T. Delivering a one-stop, integrated, and patient-centered service for patients with rheumatic diseases. SAGE open medicine. 2016;4:2050312116654404.Disclosure of I...
Background:Tofacitinib is the first oral Janus Kinasa inhibitor approved for the treatment of rheumatoid arthritis (RA); and although it is approved both after conventional treatment and after biological therapy, it is not well known its real-life effectiveness in both cases and if it is preferable to use it after cDMARDs or biologics.Objectives:We compare the effectiveness and safety of Tofacitinib in patients with RA analyzing if better and safer Tofacitinib after cDMARDs or biologics.Methods:A retrospective analysis of a real-world cohort of patients with RA, who were treated with Tofacitinib in last 3 years, as first line of treatment (T1) after failure with cDMARDS and second line of treatment after biologic drug failure (T2). The therapy was considered effective with the change from moderate-high disease activity to low disease activity or remission measured by DAS28, in those who met criteria of high adherence, without change or addition of other conventional DMARDs, without new dose or increase of dose of oral glucocorticoids. A logistic model of regression was performed to evaluate de differences between T1 and T2, using as covariates sex, age, comorbidities, time of disease evolution, adverse events and other causes of discontinuation. Medication survival time and the main causes of suspension were measured. Mixed model regression and least-squared means were used to estimate the baseline changes and a Kaplan-Meyer survival analysis to estimate time to remission and drug survival.Results:105 patients with RA were included (median age: 56.1 ± 11.7 years; 80.9% female, median disease duration 11.48 ± 10.1 years); 43% (45/105) of patients with positive rheumatoid factor and 73% (77/105) positive anti-citrulline antibodies. Regarding treatment 51% (54/105) used Tofacitinib as 1T, after failure to cDMARDs; on the other hand, Tofacitinib was used as 2T, after failure to biologics in 49% (51/105) of patients. DAS28 levels were reduced at 8, 16 and 24 weeks with statistical difference (p value 0.004, <0.0001, and <0.001, respectively). HAQ-DI also reported reduction but without statistical difference. The use of Tofacitinib was more effective after failure to cDMARDs (p value 0.014) and patients with more than 3 years of disease (p value 0.04), a statistically better response. Also, corticoids use, positive RF, extended release tablet of tofacitinib reported better changes of DAS28 but without statistical significance. Patients with high disease activity treated with Tofacitinib 1T decreased from 30% at baseline to 19% at the last follow-up; patients in 2T way were in moderate activity of the disease in 57% at baseline and went to 37% in the last follow-up. There was an increase in patients who achieved remission in both groups, but higher in 1T where they went from 9% to 41%, while in 2T they went from 22% to 33% (p < 0.05). The survival rate of the medication was 1.7 years in 1T and 2.1 in 2T; in terms of time to remission, the use of Tofacitinib monotherapy presented statistical difference (p value <0.001). The main cause of suspension of treatment was therapeutic failure 12% (13/105), 9% in 1T (5/54) and 16% (8/51) in 2T (p <0.005). 6% of patients (6/105) presented suspension due to the occurrence of adverse events, 4% (2/54) in 1T and 8% (4/51) in 2T (p <0.005).Conclusion:In patients with RA, the use of Tofacitinib as the first line of treatment (after failure to cDMARDs) is better in effectiveness and safer in comparison with its use as a second line of treatment (after biologics), with significant differences in the rates of therapeutic failure and occurrence of adverse events/reactions. On the other hand, concomitant corticoids use, positive RF, extended release tablet of Tofacitinib seem to increase the effectiveness of Tofacitinib in terms of DAS28 and HAQ-DI.Disclosure of Interests:Omaira Valencia: None declared, Michael Cabrera: None declared, Fernando Rodriguez: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.
Background:Rheumatoid arthritis (RA) is an inflammatory, chronic disease. It leads to deformity and destruction of joints through the erosion of cartilage and bone. Patients with RA report to suffer symptoms in hands, joints, swelling, loss of motion, muscle weakness among others.(1).Centers of excellence in RA have proposed a multidisciplinary model of care with an initial diagnosis, treatment prescription and follow-up with a rheumatologist, periodic consultations with a physiatrist, psychologist, physiotherapist, occupational therapy, nutrition and a patient focused program(2). With this model of care, the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. However, if the patient does adhere the model becomes ineffective.Objectives:The aim of this to report the attendance to a multidisciplinary model of care for patients with RA that attend to a specialized center in Colombia, before and after enrolling in a educational program.Methods:We performed a descriptive study. Patients enrolled our educational program in July 2019. In our institution patients are followed-up under T2T standards and a multidisciplinary approach, as part of our model of care they have periodic consultations with a rheumatology, physiatrist, psychologist, physiotherapist, occupational therapy and nutrition. We collected sociodemographic data, DAS28, and compare the attendance to each specialty at the beginning and at 6-month follow-up. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity and adherence at the beginning of the program and after six months of attendance.Results:We included 229 patients; mean age was 59 years ±10; 93% were female. At the beginning of our program, mean DAS28 was 2.57 ± 1.19, from all patients 65% were at remission, 11% at low disease activity 19% at moderate disease activity and, 5% at severe disease activity. Regarding adherence to our model, the medical specialty with the highest attendance was rheumatology (30%) followed by, physical therapy (16%) physiatrist consultation (15%) psychology (13%) and, occupational therapy (11%); the specialty with the lowest attendance was nutrition (8%). After six months of attendance to the educational program, we found an increasing number of patients in remission 67%, low disease activity 15%, moderate disease activity 18%, we did not have patients with severe DA28. Regarding the medical specialties, we found a 3% rise in the attendance to the nutrition consultation and psychology consultation. We did not find statistical association between disease activity and adherence to the model.Conclusion:These results are a clear example of how an educational program is capable of increasing awareness and improving the clinical outcomes and adherence to a multidisciplinary model for approaching RA. As other studies have shown(3), patient education interventions improve adherence to medication and to attendance to health care specialists.References:Santos-Moreno P, Castaneda O, Garro B, Flores D, Sanchez G, Castro C. From the model of integral attention to the creation of centers of excellence in rheumatoid arthritis. Clinical rheumatology. 2015;34 Suppl 1:S71-7.Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient preference and adherence. 2019;13:119-29.Acknowledgments:This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid ArthritisDisclosure of Interests:Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.
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