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1215
Health Professionals in Rheumatology Abstracts
AB1140-HPR
SENIOR RHEUMATOLOGYSTS, JUNIOR
RHEUMATOLOGYSTS, NURSE SPECIALISTS AND
PATIENTS WITH SIMILAR DISEASES – FOUR SOURCES
OF INFORMATION FOR RHEUMATIC PATIENT NOT
EQUALLY VALUED, NOT EQUALLY USED
M. Dobroiu 1 , D. Vasile 1 , C. Ioan 1 , C. Aproianu 2 , D. Predeteanu 3 , C. Popescu 1 ,
E. Ursa 4 , C. Coroianu 4 , C.E. Stanescu 5 , M. Popescu 2 , M. Jercan 6 ,
F. Berghea 3 , R. Ionescu 3 , on behalf of RCRD. 1 Rheumatology, Sf. Maria
Hospital; 2 Rheumatology, I Cantacuzino Hospital; 3 Rheumatology, Carol Davila
University Of Medicine And Pharmacy, Bucharest; 4 Rheumatology, County
Hospital, Cluj-Napoca; 5 Rheumatology, Dr. Stoia Hospital, Bucharest;
6
Rheumatology, Sf Apostol Andrei - Hospital, Constanta, Romania
Background: Chronic rheumatic patients have to face various needs of communication throughout their illness. Their doctors, nurses and fellows suffering
from similar diseases are the main oral sources of information. Based on their
availability, perceived competence, presumed quality or easiness to access these
sources are used to address the information needs. In order to improve their
education of is important to know the way our rheumatic patients use these
sources to fulfill their information needs.
Objectives: To identify the patients’ preference for a certain source of information
in relation with their particular needs.
Methods: A structured questionnaire developed to assess the preference for one
of the four main source of information (senior & junior rheumatologists, nurse
specialists and similar patients) in relation with 12 problems connected in 5 areas:
diagnostic & treatment, alternative management, impact of disease, dealing with
administrative obstacles and source of additional information. For each item we
determined the level of preference as a mean of answers (on a 0 to 10 scale) we
received. 205 rheumatic patients from five tertiary centers accepted to answer the
questionnaire. SPSS 19.0 have been used for statistical analysis and a p<0.05
was considered significant.
Results: The highest levels of preference (mean (SD)) for information given by
specialized nurses have been computed for: additional source of information (7.3
(2.7)), future evolution of disease (7.2 (2.9)), impact of disease on personal life
(7.1 (2.8)), seriousness of disease (6.9 (2.7)), adverse reactions to treatment (6.8
(2.7)). However in none of 12 problems the nurse was not the most preferred
source of information and in just one case she was the 2nd best choice. Patients
with lower levels of formal education and those from urban areas scored higher
for nurses but did not changed the hierarchy. Nor the disease duration or the
gender of responder have influenced the final results.
Conclusions: The study reveals a potential need for strengthening the role of
specialized nurse as a quality source of information for chronic rheumatic patients
in the context of her increasing role in long-term management. However, the
areas we identified in this study as being higher rated for nurses might benefit
from their input even sooner. Specialized nurses should develop their own action
plan to solve this issue in the benefit of our patients.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.2689
AB1141-HPR
TEAM MANAGED CARE FROM A PATIENTS
PERSPECTIVE: A STUDY OF BIOLOGICAL PATIENTS AT
A CANADIAN CENTRE
D. Heap 1 , M. Deamude 2 , M. Saldanha 2 , C. Mech 2 , H. Ross 2 , L. Vanstone 2 ,
W. Bensen 2,3,4 . 1 Rheumatology Health Team Hamilton, Hamilton;
2
Rheumatology Health Team Hamilton, Hamilton, Ontario; 3 St. Joseph’s
Hospital; 4 McMaster University, Hamilton, Canada
Background: In Canada, there is a widening care gap in Inflammatory Arthritis
due to the increased aging population, higher disease prevalence, dwindling
numbers of practicing rheumatologists and decreased access to care. As a result,
there is delay in diagnosis, initiating treatment, and in starting biological therapy.
In 2008, our practice developed a team based program where trained Registered
Nurses were assigned as the primary care nurse to patients receiving biological
therapy in order expedite and more efficiently manage patient care. Currently
more than 1300 biological patients are followed in the clinic.
In this unique to Canada practice, patients are seen and assessed by a registered
nurse who does a complete history, reviews medications, assesses joints, and
provides health teaching. The nurse then discusses the patient and their needs
with the Rheumatologist, and together they devise a plan which the nurse then
implements and follows through.
Objectives: To determine patients perception of team managed care in rheumatology.
Methods: 175 consecutive patients with a confirmed diagnosis of inflammatory
arthritis (Rheumatoid Arthritis, Ankylosing Spondylitis or Psoriatic Arthritis)
receiving biological therapy between May and June of 2013 were given a
confidential survey with 15 questions to determine their level of satisfaction with
a multidisciplinary approach to care. They were asked questions regarding their
general demographics, current treatment, and their confidence in the nurse that
primarily follows them, whether or not the team addresses their questions or
concerns, and treatment goals. 22 questionnaires had more than 2 questions left
blank and therefore withdrawn from analysis.
Results: More than 150 patients surveyed were included in this analysis studying
patient satisfaction using a team approach model of patient care. The majority of
patients surveyed were middle aged (40-75) and predominantly female. 85 percent
of patients strongly agreed that they felt comfortable discussing their health and
issues centring on their arthritis treatment with the nurse and confirmed that these
goals were discussed at each visit. 97 percent of patients were confident in the
nurse’s assessment skills and ability to manage their arthritis care and 99 percent
of patients valued this team based model of care in comparison to seeing the
physician alone.
Conclusions: Our results from this study demonstrate a high degree of confidence
in team- based rheumatology care. Currently this practice manages the biological
volume of about 10 clinical rheumatologists who practice independently. Nurses
are able to establish a rapport with patients in a unique and different way than
a physician, and are not only able to address the patient’s physical needs but
their psychosocial issues as well. Patients have the confidence that these highly
trained specialty nurses are providing them with optimal care, allowing them
to work toward achieving targeted treatment goals and better arthritis disease
control. This study affirms that team managed care is the only way to meet treat
to target guidelines in our exponentially growing disease prevalence.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.3003
AB1142-HPR
NURSING DIAGNOSES AND INTERVENTIONS FOR
PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS
K. Veetõusme. Rheumatology, East-Tallinn Central Hospital, Tallinn, Estonia
Background: Systemic lupus erythematosus (SLE) is a chronic systemic
autoimmune disease of currently unknown etiology. Clinical manifestations of SLE
are diverse and changing with time; it is a rare disease that can be life-threatening.
Basic nursing training gives a general overview of SLE. For a nurse working
with rheumatic patients, SLE is a challenging disease, which requires additional
knowledge on the nursing care of patients with SLE.
Objectives: To describe the nursing diagnoses and interventions for patients with
SLE.
Methods: An overview of relevant literature, published from 2003 to 2012.
Presented here is a part of the author’s graduation project at the Tallinn Health
Care College.
Results: The leading SLE patients’ nursing diagnosis is pain, including arthralgia
and myalgia in 95% (1), headache in 30-70% (2, 3), pleurodynia in 45-60%,
abdominal pain in 30% (4) of cases. The other common diagnoses are fatigue (6790%; 5), impaired physical activity (66%; 6), disturbed body image, and chronic
unhappiness. SLE ’s main nursing problems are not life-threatening, but they do
have a noticeable effect on the patient’s physical, social and psychological function.
Nursing interventions include assessment and monitoring of the patient’s mental
and physical condition, patient teaching, counseling and encouragement according to the patient’s needs and level of education. An effective nursing intervention is
characterized by the improvement in SLE patient’s adaptation and mental health.
Conclusions: Identification of the problems of a SLE patient are particularly
challenging due to great variation of the patient’s individual concerns. Successful
cooperation between a nurse and a SLE patient, which forms a solid basis for
improving the patient’s quality of life and coping, requires sound knowledge of
SLE from nurses.
References:
[1] Birkenfeldt, R., Haviko, T., Kallikorm, R., Kull, M., Kuuse, R., Pruunsild, C.,
Tamm, A., Tender, M. (2012). Reumatoloogia. Tallinn: Medicina.
[2] Weder-Cisneros, N. D., Téllez-Zenteno, J.F., Cardiel, M. H., Guibert-Toledano,
M., Cabiedes, J., Velásquez-Paz, A.L., García-Ramos, G., Cantú, C. (2004).
Prevalence and factors associated with headache in patients with systemic
lupus erythematosus. Cephalalgia, 24(12), 1031–1044.
[3] Ainiala, H. (2011). Neuropsychiatric Involvement in Systemic Lupus Erythematosus. Tampere: University of Tampere.
[4] Bertsias, G., Cervera, R., Boumpas, T. D. (2012). Systemic Lupus Erythematosus: Pathogenesis and Clinical Features. 476- 505.
[5] Cleanthous, S., Tyagi, M., Isenberg, D. A., Newman, S. P. (2012). What do we
know about self-reported fatigue in systemic lupus erythematosus? Lupus,
21(5), 465-476.
[6] Katz, P., Morris, A., Trupin, L., Yazdany, J., Yelin, E. (2008). Disability in
Valued Life Activities Among Individuals With Systemic Lupus Erythematosus.
Arthritis and Rheumatism, 59(4), 465–473.
Disclosure of Interest: None declared
DOI: 10.1136/annrheumdis-2014-eular.4249
AB1143-HPR
A PILOT STUDY OF A STANDARDIZED EDUCATIONAL
PROGRAMME FOR THE IMPROVEMENT OF CHRONIC
PAIN AND FATIGUE IN SYSTEMIC LUPUS
ERYTHEMATOSUS (SLE)
L. Cano-Garcia, C.M. Romero-Barco, S. Manrique-Arija, I. Ureña-Garnica,
F.G. Jimenez Nuñez, M.D.C. Ordoñez-Cañizares, L. Nieves-Martín,
N. Mena-Vázquez, M.V. Irigoyen-Oyarzabal, A. Fernández-Nebro.
Rheumatology, Hospital Regional Universitario de Málaga, Málaga, Spain
Objectives: To evaluate the effectiveness of a standardized educational interven-
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