Session Title: Clinical Practice/Patient Care
Session Type: Abstract Submissions (ARHP)
In 2008, the American College of Rheumatology (ACR) developed recommendations for use of non-biologic and biologic DMARDs in the treatment of rheumatoid arthritis (RA). The purpose of this study was to assess change in baseline screening practices following completion of an educational intervention reflecting the ACR recommendations.
An educational intervention designed to update providers in and new recommendations from the ACR was completed in an outpatient rheumatology clinic in September 2009.
Staff education activities included: 1) individual review of the ACR 2008 Recommendations for the Use of Non-biologic and Biologic Disease-Modifying Antirheumatic Drugs in Rheumatoid Arthritis (DMARD); 2) development and review of “DMARD reference” sheets; 3) formal presentation of key points from the journal article to clinic staff.
Retrospective chart reviews were completed on new RA patients seen in a hospital-based outpatient clinic for a six month period immediately before and after review of the guidelines. Documentation of recommended baseline screening test results (laboratory studies, imaging and tuberculosis testing) for DMARD was assessed.
Inclusion criteria: 1) New patient to rheumatology between 04/01/2009 and 03/31/2012 (NPW); 2), rheumatoid arthritis, inflammatory arthritis (ICD 9 codes 714.0 and 714.9); 3) DMARD (methotrexate or leflunomide) therapy planned.
Exclusion criteria: 1) Alternate diagnosis after initial or subsequent evaluation; 2) no DMARD (methotrexate or leflunomide) treatment; 3) follow up appointment(s) cancelled or not attended; 4) not a new patient to rheumatology clinic; 5) current therapy with DMARD (prescribed at alternate site).
Baseline screening data for DMARDs and biologic agents was consistently identifiable in the patient record.
A file for all patients with diagnosis code of 714.0 and 714.9, seen anywhere in the hospital/clinic system between 10/2007 and 12/2010, arriving as an NPW in rheumatology was reviewed. There were 256 patients seen between 04/01/2009 and 03/31/2010. 184 records were reviewed. Data for 144 records were excluded and data from 40 records (n= 20 pre-intervention; n= 20 post-intervention) were included.
Comparison of the results (CBC, LFTS, CREA, ALB, HEP B, HEP C, and CXR) for the two groups was completed using a χ² analysis and Fisher’s exact test and there was no significant difference between pre and post scores.
Baseline screening for DMARD therapy was completed in ≥ 90% of the baseline for CBC, LFTs, CREA and ALB in both the pre and post intervention periods. Hepatitis B and C screening was completed in ≤ 25% of the pre and post intervention screenings. CXR was completed in 20% of the pre-intervention baseline screenings and 50% of the post-intervention screenings but this difference did not achieve statistical significance.
Completion of recommended baseline screening testing for patients receiving DMARD treatment did not increase after the educational intervention. This is constant with other failed attempts to change clinician behavior through short term educational interventions. This suggests that incorporating work flow redesign into the electronic medical record is likely to be more effective.
D. C. Lloyd,
J. N. Mecchella,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/baseline-screening-recommendations-for-rheumatoid-arthritis-patients-treated-with-disease-modifying-anti-rheumatic-drugs-does-an-educational-intervention-change-practice-in-an-outpatient-clinic/