Session Title: Innovations in Rheumatologic Care
Session Type: Abstract Submissions (ARHP)
The Educational Needs Assessment Tool (ENAT) is a quick and simple, self completed questionnaire that ensures that patient education is relevant, appropriate and timely for people with Rheumatoid Arthritis (RA). It has been validated for use in RA and six other rheumatic diseases and has been cross-culturally adapted into nine European languages. Our aims were (i) to evaluate the effectiveness of ENAT focused patient education on self-efficacy, patient knowledge and health outcomes (physical function, symptoms, role/work, social interaction and psychological status/affect) (ii) to evaluate the usability of the ENAT in clinical practice, from both a practitioner and patient perspective.
This was a mixed methods (quantitative and qualitative) study conducted in seven rheumatology centres across the United Kingdom. Patients were randomised to either the ENAT group (EG) where patients completed the ENAT which was then used as a template by the Nurse Practitioner (NP) to meet their educational needs; or usual care (UC) by NP without the ENAT. Patients were seen at baseline then at weeks 16 and 32. The outcomes were self-efficacy (ASES), health status (AIMS2-SF) and patient knowledge (PKQ). The primary outcome was self-efficacy (ASES) at week 32. The ASES has two subscales: ASES-Pain and ASES-Other symptoms.
A total of 132 patients were entered into the study of which 70 received ENAT (53%) and 62 usual care (47%). At week 16, there were no significant between-group differences. By week 32, the ASES mean scores, were higher for the ENAT group than the usual care group; ASES-Pain, MD=4.36(95%CI: 1.17, 7.55), t=2.72, P=0.008; ASES-Other symptoms, MD=5.84(95%CI: 2.07,9.62), t=3.07, P=0.003). (Bonferroni-adjusted P-value = 0.025 for significance at the alpha level). While there were no significant changes in ASES scores in the usual care group over the whole follow-up period, the ENAT group saw significant improvements in ASES-pain and ASES-Other symptoms scores, suggesting that the ENAT helped improve patients’ self-efficacy. Initially, patients were asked if they wanted any education about their arthritis (yes/no); at week 0, 33 patients (48%) said ‘yes’ and this dropped to 13 (21%) at week 16 and 9 (16%) by week 32 (Chi Sq.=18.76, p < 0.001). Trends over time reveal significant decrease in the overall ENAT score for all domains (managing pain, movement, arthritis process, self-help measures and support) except the feelings domain. The decrease in the total ENAT score by the end of the study, indicates that patients' educational needs were being met effectively.
Qualitative interviews were undertaken with patients and Nurse Practitioners. All found the ENAT to be a comprehensive and easy to use tool. For most patients, the process helped them to focus on what they needed to know from the NP and for some, it made them think of additional questions to ask and topics to think about. Both the EG and the CG perceived that they were getting a good and adequate education provision from their NP.
This is the first study to report the effects of ENAT-focused education in people with RA. The results of the primary outcome (ASES-Pain and ASES-Other symptoms) suggest that the ENAT could be a useful addition to usual care.
A. O. Adebajo,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/evaluation-of-the-effuc-educational-needs-assessment-tool-enat-focused-patient-education-on-health-outcomes-in-patients-with-rheumatolid-arthritis-a-randomised-controlled-trial/