OP0206-HPR Outpatient follow up on demand for patients with rheumatoid arthritis – a two-year randomised controlled trial. (12th June 2018) - Sweeney, A.-M.T.
Abstract : Background: Medical treatment and care are often life-long in patients with rheumatoid arthritis (RA). During periods of stable illness, patients typically attend routine visits every 3–8 months at the rheumatology outpatient clinic. The arthritis may flare up between scheduled medical visits, but it may be difficult to get acute appointments with the rheumatologist. Scheduled routine visits may be in a stable and 'good' period without any symptoms and with no need for control and adjustment of treatment and care. 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 new outpatient system based on patient self-controlled outpatient follow up (Open Outpatient Clinic System (OOCS)) with traditional scheduled routine visits at a rheumatology outpatient clinic. Methods: A two-year RCT 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 area of (Denmark from Feb 2015 to Jan 2017) Patients were randomised electronically and stratified regarding bio-medicine. Joints were examined by a blinded rheumatologist. Patients in the intervention group received information about the disease, symptoms, treatment and use of the OOCS. Appointments for the control group were scheduled according to routine procedures. Outcome measures were collected at baseline, year 1 and year 2. Clinical parameters: Disease Activity Score 28 (DAS28), CRP, Visual Analogue Scale (VAS) pain and fatigue, number of tender and swollen joints (28 joints), X-ray of hands and feet. Psychological parameters: VAS patient satisfaction, VAS patient trust, VAS patient involvement and quality of life (EQ-5D). Results: 289 patients were included, 253 completed the 1 st year, 158 the 2nd year. The OOCS at year one and two was comparable to traditional scheduled routine procedures regarding clinical and psychological outcome measures. No radiological progression was detected. Patients in the intervention group made more phone calls to the clinic (244 versus 55) and had fewer visits compared to the control group (424 versus 513). Main results are shown in the table 1. Conclusions: The OOCS met RA patient preferences for RA appointments and was comparable with traditional scheduled routine procedures regarding clinical and psychological outcomes after one year. Thus, the OOCS could provide a basis for a future organisation of outpatient care for patients with RA. Disclosure of Interest: None declared