Ab1616-HPR Evaluating the Impact of Implementing a Dedicated Eia Counselling Clinic on Dmard Initiation Time

Background: Early diagnosis of inflammatory arthritis and appropriate treatment with disease modifying anti-rheumatic drugs (DMARDs) can improve long term outcomes for patients. The National Institute for Health and Care Excellence (NICE) Quality standard 33 recommeds patients commence DMARD treatment within 6 weeks of referral from primary care and are provided with educational actitivies to support self-care. This data is reported in the British Society for Rheumatology National Early Inflammatory Arthritis Audit. The early inflammatory arthritis (EIA) clinic at Stepping Hill hospital is a weekly clinic reserved for direct referrerals from primary care with suspected EIA. Following a positive diagnosis, patients are then referred to a dedicated EIA pharmacist lead counselling clinic which was introduced in October 2021 to ensure prompt initiation of DMARD treatment. Objectives: To assess whether the intervention of creating specific EIA pharmacy counselling clinics reduced treatment initiation time for patients diagnosed in the EIA clinics at Stepping Hill hospital. To also determine whether patients are diagnosed and commenced treatment for inflammatory arthritis within 6 weeks from referral and receive full education about their treatment, following NICE guidance. Methods: A retrospective data set with 30 patient's pre-intervention (attended the pharmacist EIA clinic from 05/12/19 to 05/10/21) and 30 patients post-intervention (attended the pharamcist EIA clinic from 09/03/23 to 12/10/23) was used to collect data. Evolve® was used to identify the date the EIA referral from the General Practitioner (GP) was receieved by the rheumatology department. The date GPs were presented with a specific documented treatment plan and asked to commence DMARD medication via Advantis CDS® clinic letter was taken as the date for treatment intiiation. Clinic letters were reviewed to confirm education had been provided. Data was recorded and analysed on Microsoft Excel. Patient specific data was not recorded. Results: The average number of weeks taken from referral to treatment was 7 weeks in the pre-intervention group and 4 weeks in the post-intervention group. The average time taken from diagnosis to to treatment initiation was 2.8 weeks in the pre-intervention group and 1.3 weeks post-intervention group. Within the pre-intervention group, patients commenced DMARD treatment between 1-6 weeks followin diagnosis. The patents within the post-intervtion cohort commenced treatment within 3 weeks of diagnosis, 77% of these patients were treated within one week of diagnosis. All patients included in this study recieved full medication counselling. Conclusion: This audit identified that introducing a dedicated counselling clinic for early inflammatory arthritis helped reduce the wait time for patients to be treated for their condition and allowed patients to be treated within the time frame set out by NICE quality standard of 6 weeks from referral. REFERENCES: 1 National Institute for Health and Care Excellence (NICE)Quality statement 2: Treatment: Rheumatoid arthritis in over 16s: Quality standards Internet. cited 2023 Dec 26. Available from: https://www.nice.org.uk/guidance/qs33/chapter/Quality-statement-2-Treatment. Acknowledgements: Stepping Hill Rheumatology Team. Disclosure of Interests: None declared.