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Background: The ageing demographics of many European countries will result in a greater number of people diagnosed with disease, particularly those correlated with older age. In many European countries, people of older age tend to migrate from urban to rural and coastal areas. Polymyalgia Rheumatica (PMR) is strongly correlated to age, with rising incidence in each ten-year age band after the fifth decade of life. There is wide variation in glucocorticoid prescription and most patients are currently cared for by community-based practitioners. Whilst most patients can be managed effectively within the community, enhanced use of routinely collected data and better integration of data and services may result in improved outcome. Objectives: To improve support for community-based practitioners caring for people living with PMR. Methods: Working with Prescribing Services Limited (PSL) and key stakeholders, we developed a community-based practitioner support programme (PMR IMPROVE). PSL Advice and Guidance System (ECLIPSE Live) gained NHS Digital central assurance in 2017 and processes NHS data for 27 million people living in England, with risk stratification for unplanned hospital admissions. ECLIPSE is a data processor, fully integrated with all NHS England primary care records systems with bi-directional dataflow to and from NHS systems. We identified patients with a diagnosis of PMR within ECLIPSE and developed tools, including patient-portal, digital steroid card, structured medication review and Advice and Guidance recommendations to general practitioners (GPs) to pilot the new system in a Primary Care Network of 7 practices in West Norfolk, UK. Results: Over 100,000 patients had a diagnosis of PMR, resulting in a point prevalence of 2.2% in those greater than 55 years of age. Iterative development of patient-reported outcome measures (PROMs) based on current evidence was implemented within a region of Norfolk UK, thorough an enhanced Advice and Guidance programme on ECLIPSE Live. All patients with PMR (n=450) on steroids (n=150) were asked to complete PROMS, issued with a digital steroid card and given access to the patient-engagement portal. Recommendations on steroid tapering were given by partnering rheumatologists, based on PROMs and C-reactive protein (CRP) levels. Within the patient portal, patients could view a graphic display of their average weekly steroid use overlaid with CRP results and have access to exercise information. Suggestions by partnering rheumatologists included advising patient review and referral to secondary care. Conclusion: In many countries, the number of those with PMR are as large as those with rheumatoid arthritis; changes in demographics will mean many with PMR will live in relatively dispersed rural and coastal communities. This pilot demonstrated the benefits of this enhanced support programme, which could be expanded to other common conditions and reduce hospital admissions. GPs found the system easy to use and found the use of Structure Medication Reviews with a graphic display of steroid prescriptions useful. Patients liked the support given to their GPs and improvements to their care. REFERENCES: 1 Chief Medical Officer's Annual Report 2023: Health in an Ageing Society. Acknowledgements: This work was funded by PMRGCAuk. Disclosure of Interests: Max Yates Advisory board for BioGen and Galapagos, Pratyasha Saha: None declared, Clare Aldus: None declared, Catherine Green: None declared, Julian Brown: None declared, Alex MacGregor: None declared.
Yates et al. (Sat,) studied this question.
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