Background/Purpose:  Patients are not aware of the important role of disease activity in Rheumatoid Arthritis (RA) for long term clinical outcomes. This not only prevents them from taking a more central role in the care for their own health, it also hinders rheumatologists in adhering to the tight control principle. In order to improve daily clinical practice, an improvement strategy should address patient-level barriers to tight control adherence.

Methods: The strategy was developed through a step-wise approach, in collaboration with all stakeholders and by addressing barriers to tight control on patient level. Strategies that have already proven to be successful in other chronic diseases were taken into consideration. First patient-level barriers to tight control were defined and evidence and example materials were explored. Next, a draft version was developed and improved through applying the International Patient Decision Aids Standards (IPDAS) criteria. Then, the draft was further improved by consulting an expert panel, patient research partners, and rheumatology professionals several times. The layout of the strategy was developed by consulting laymen, hospital communication departments, and patients.

Results: The DAS-pass strategy consists of two components. The first component, decision supportive information for patients, includes an informational leaflet and a patient held record. The leaflet is designed to educate patients about tight control and its importance for clinical outcomes. It aims to increase patients knowledge on tight control, to empower patients to be more involved in their own disease management, and to improve patients’ medication beliefs. With the patient held record, patients can keep track of their own disease activity scores, their RA medication (changes), and on topics to be discussed with their physician. The patient held record aims to increase understanding of the tight control principle by increasing involvement and information uptake. The second component is guidance by a specialized rheumatology nurse. By discussing the decision supportive information (component 1) during an individual consult with each patient, the nurse aims to stimulate patients to communicate about their disease activity during visits, to individualize the decision supportive information to the patients’ needs, and to offer the opportunity to ask questions or ask for additional support.

Conclusion: The DAS-pass strategy is a patient centered-strategy that was developed to improve tight control in daily clinical practice. By empowering and educating patients, it aims to improve communication about tight control between patients and rheumatologists, and to enable patients to take the initiative in tight control. We consider the DAS-pass strategy promising as it was developed systematically: theory based and in cooperation with the stakeholders. Research on the evaluation of the effects of the DAS-pas strategy in a Randomized Controlled Trial is currently ongoing. Acknowledgements: The input of all stakeholders that have helped in the development of the DAS-pas strategy is very much appreciated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/systematic-development-of-a-patient-centered-strategy-to-improve-tight-control-in-daily-clinical-practice/