104 Annual review and health promotion for patients with spondyloarthritis: development of a pro forma and early implementation

Background: NICE guidelines for rheumatoid arthritis (RA) recommend annual review (AR) for patients, but do not specify the content of that review. In our department, RA AR has been resource-intensive and had patchy uptake by patients. Although popular with a select group it gave additional health benefit in only a proportion, depending on the consultant’s routine practice. Learning from this, for patients with SpA, we aimed to devise a comprehensive, less burdensome AR process and identify opportunities for improving health outcomes.

Methods: We developed the content and pro forma as a quality improvement project using four PDSA cycles. The current pro forma is available on paper or electronically. It has been used in routine clinical practice by members of the multidisciplinary team in specialist and general clinics in 200 patients and initial results are discussed.

Results: Brainstorming and iterative development cycles produced a tabular form for clinical documentation including diagnostic information, biologic drug use, risk factors for cardiovascular disease and fracture, immunization, routine outcome measures and participation in national screening programmes. Use suggested incremental data collection by any team member at planned patient visits over a number of years rather than a specific additional appointment. In the first 200 patient’s forms were not fully completed in the initial visits, as planned. Clinical features of disease were most likely to be completed (80%), then cardiovascular (40%) and fracture RFs (35%), immunization status, and screening programmes. Opportunities to improve health outcome were identified, particularly regarding smoking cessation, reduction in cardiovascular risk and in uptake of screening programmes. Areas for improvement include accessible recording of Bath outcome measures and of HLA B27 status, which is not available on our electronic health record. One patient went on to participate in bowel cancer screening following consultation, and was found to have a resectable polyp.

Conclusion: We have produced a pro forma which can be used to record important features of SpA patients’ disease and opportunities to improve health outcomes. It is not practical to complete all sections in a single routine clinic visit. Having all the diagnostic information in one place can improve our recording. Duplication can be reduced e.g. asking about routine immunization. Multidisciplinary input is a strength - it’s everyone’s job. We have identified opportunities to improve health e.g. advocating for bowel cancer screening, reinforcing smoking cessation advice, recommending statin treatment. We will continue to pilot this service and anticipate an electronic implementation in due course.

Disclosures: L. Kay: None. M. Rutherford: None. L. Tiffin: None. K. Nicholl: None. N. Marshall: None. M. Motion: None. B. Thompson: None. R. Duncan: None.