Fri0652-Hpr development of the Advanced Practice Nursing Consult in Rheumatology in the Multidisciplinary Approach of Inflammatory Diseases Mediated by Immunity

Abstract

Background:Patients with immunity mediated inflammatory diseases (IMID) often have clinical manifestations and comorbidity in the field of various medical specialties. A center has been created in our hospital for the comprehensive care of patients with IMID. It is an innovative healthcare model, that incorporate patients into its governance. Physicians, pharmacists and advanced practice nurses (APN), collaborates in consultation or in the day hospital (DH).Objectives:To analyze the activity of the rheumatology APN consult integrated in the multidisciplinary team, and the impact on health care and quality of life on IMID patients.Methods:Descriptive study of the rheumatology APN activity since the opening of the center for a year. The APN consultations were face-to-face (scheduled or demanded) or by telephone. Variables measured: demography, diagnosis, treatments, clinic activity and patient reported outcomes (PRO). In the face-to-face consultation, was included: integral valuation (clinic, functional and psychosocial), education for Health (information about disease and treatments, adverse effects, healthy living habits), drug administration, emotional support. In the telephone consultation, the rheumatology APN is the reference professional for monitoring, question solving and advice in case of flare or adverse event.Results:721 patients were evaluated, mean age 54.6 years, (range, SD) (20-90, 13.9), 61.3% women, with a total of 1737 consults. Diagnosis: 324 (44.9%) RA, 221 (30.6%) SpA, 100 (13.9%) PsA and 76 (10.5%) other diseases. Treatment modality: IV 293 (40.4) SC 399 (55.3%) and oral 29 (4.0%). Rheumatology APN activities are described in Table 1. 1415 face-to-face consultation were made, 82.7% scheduled and 17.2% demanded either by the patient, the rheumatologist or another member of the multidisciplinary work-team. Among the face-to-face consultations, 62 (4.4%) patients were attended the same day in the medic consult due to disease flare or other disease problems, 38 (2.7%) patients were sent to another specialist of the work-team due to co-morbidity. The activity executed in the rheumatology APN consultation is shown in Table 2Table 1.Educative interventions by the APN.•Information about the disease•Information about the treatment•Medicine administration•Adverse effects of the medicine•Healthy life style habits•Vaccines•Evaluation of cardiovascular risk•Signs and symptoms of alerts due to the pathology•Ongoing following of the evolution of the disease.•Support for the achievement of the treatment and possible difficulties.Table 2.Activity done in the consult. N° 1.737Face-to-face activityN° consults 1.415Non face-to-face activityN° consults 322Complete valuation due to necessities721 (51%)Valuation58 (18.0%)Educative Interventions1.305 (92.2%)Questions96 (29.8%)Valuation and following1.372 (97.0%)Test result26 (8.1%)PRO execution1.156 (81.7%)Articular counting’s733 (51.8%)Valuation of the diseases activity•DAS28 PCR•ASDAS-PCR737 (52.1%)419 (26.6%)Process of appointment•Requested by the doctor•Requested by the patient.105 (32.6150 (47.0%)55(53.0%)Cardiovascular risk valuation.721 (51.0%)Derivative to different medical consults37 (11.5%)Blood extraction724 (51.2%)Solved by APN285(88.5%)Analytics monetarization1.171 (82.8%)Medicine monetarization1.372 (97.0%)Day Hospital ManagementConclusion:The rheumatology APN takes a vital part in the multidisciplinary team, offering a holistic approach, as well as efficient and high-quality care, offering quick response, reducing waiting time and becoming an important part of this patient-centered model.Disclosure of Interests:None declared

Características clínicas de los pacientes con enfermedades inmunomediadas inflamatorias afectados por Covid-19

“…[22][23][24] El Centro de Enfermedades Inmunomediadas Inflamatorias (CEIMI), proporciona atención integral, seguimiento y tratamiento en Hospital de Día (HdD), de pacientes con una o varias patologías EIMI. 25,26 Esta unidad cuenta con un equipo pluridisciplinar compuesto por médicos especialistas en Reumatología, Enfermedad Inflamatoria Intestinal (EII) y Dermatología y, además, Enfermeras de Práctica Avanzada (EPA) de cada una de estas especialidades que realizan atención presencial y telemática. Esta última, se realiza por teléfono y correo electrónico con el objetivo de dar respuesta a las dudas de los pacientes sobre tratamiento, aparición o cambios en la sintomatología asociada a la enfermedad, vacunas, etc.…”