Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology.

OBJECTIVE: To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS: The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS: The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION: A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Clinical and therapeutic management of rheumatoid arthritis with biological disease-modifying antirheumatic drugs: RADAR study.

To describe the clinical and therapeutic management of rheumatoid arthritis (RA) patients with biological disease-modifying antirheumatic drugs (bDMARDs), alone or in combination with conventional synthetic DMARDs (csDMARDs), as well as analysing changes over time in bDMARD use. An observational, retrospective, multicentre study was conducted in the rheumatology departments of 10 public Spanish hospitals. Patients with RA treated with bDMARDs at baseline who had medical records available in the data collection period 2013-2016 were included. All visits to rheumatology departments recording any type of bDMARD modification (dose, etc.) were collected. Clinical characteristics, concomitant treatment, resource use, work productivity and quality of life (QoL) were recorded. 128 patients were included: 81 received first-line bDMARD treatment, 28 second-line bDMARD treatment and 19 received third or later lines. Mean study follow-up was 4.1 years. Assessment of DAS28 was available in 54.6% of visits. At baseline, 48.7% of patients had moderate-high disease activity. At final observation, 69.5% of patients continued with the first bDMARD. Tumour necrosis factor blockers were administered to 85.2% of patients in first line, 45.7% in second line and 18.1% in third or later lines. At final observation, 80.2% of patients still felt pain/discomfort. As expected, those with higher disease activity had higher loss of work productivity and lower QoL, as assessed by DAS28, than patients with lower disease activity. Drugs represented 82.6% of the total cost. In this Spanish cohort of 128 patients, most patients remained on the first prescribed bDMARD, despite remaining signs and symptoms.

Un estudio de seguimiento multicéntrico en pacientes con gonartrosis tratados con inyecciones intraarticulares de ácido hialurónico / A multicentre follow-up study of gonarthrosis patients treated with intraarticular injections of hyaluronic acid

Fundamento: El objetivo de este estudio fue valorar la eficacia y seguridad del tratamiento con cinco inyecciones intraarticulares de ácido hialurónico (Adant(r), Tedec-Meiji Farma, S.A., Madrid) en pacientes con gonartrosis mediante un estudio prospectivo multicéntrico, abierto y no controlado en condiciones asistenciales reales con un seguimiento de 6 meses. Material y métodos: Se incluyeron 243 pacientes en 42 centros españoles, siendo evaluables 237. Los pacientes presentaban diagnóstico clínico y radiológico de artrosis de rodilla, clasificados por el grado radiológico siguiendo la escala de Kellgren-Lawrence: Se utilizó la escala visual analógica (EVA) para valorar el dolor espontáneo y en actividad estandarizada y el goniómetro para la movilidad articular antes y después de finalizar el tratamiento. La eficacia fue evaluada además por el paciente y por el investigador (escala Likert). Resultados: En todas las visitas de seguimiento con respecto a la situación basal hubo disminución del dolor (p < 0,0001) y mejora de la función articular (p < 0,0001) con independencia del grado de artrosis. Estos resultados se confirman por la evaluación del investigador, 6 meses después del tratamiento (el 75 por ciento respuesta excelente o muy buena, el 6,5 por ciento buena, el 8,2 por ciento regular y el 10,3 por ciento nula). No hubo diferencias estadísticamente significativas transcurridos 6 meses entre pacientes con artrosis de grado I-II y III. Se registraron 23 acontecimientos adversos, 16 locales y de carácter leve y ninguno grave. Conclusiones: El ácido hialurónico es un tratamiento seguro, sintomático de acción lenta y duradera (SYSADOA) con resultados beneficiosos tanto para artrosis leves como graves, como se demuestra en este estudio de seguimiento de 6 meses de duración. (AU)