AB1541-HPR IMPACT OF COUNSELLING, TELEPHONE-BASED SYMPTOMS TREATMENT TITRATION AND REMINDER CALL ON REGULAR FOLLOW UP AMONG COMMON RHEUMATOLOGIC DISORDERS; A PROSPECTIVE COHORT STUDY

Abstract

BackgroundPoor adherence to rheumatologic diseases exist for various reasons.ObjectivesThe objective of the study was to measure adherence with interventions.MethodsIt was a prospective cohort study for 52 weeks. Assuming adherence of 30%, power of the study as 90% and confidence interval 95% sample size was calculated as 323. Common rheumatologic disorders (Rheumatoid arthritis (RA), Spondyloarthropathy (SpA), Primary Sjogren’s Syndrome (PSS) and Systemic Lupus Erythematosus (SLE)) patients with at least 15% from each group who presented first time in our clinic were followed up. The interventions were two separate sessions of face-to-face counselling during first initial visits, telephone-based titration of drugs if there was poor control of the presenting symptoms and two-day prior reminder phone call for next follow up.ResultsAmong 323 enrolled patients 27% were compliant with previous treatment. The relative ratio of compliant groups under follow up with the rheumatologist verses other clinicians was 2.2. Median duration of diagnosis of the 60% previously diagnosed verses 40% newly diagnosed at our clinic was 18 months verses 7 days. Among 64 cases of PSS 86% were undiagnosed with median duration of symptoms of 4 years. Knowledge about consequences of poor treatment between pre verses post counselling was 40% and 78% respectively. (Table 1) Symptom controlled with telephone-based drug titration was achieved among 84% of cases (30%, 44%, 10% partial, nearly complete and complete improvement respectively). With the reminder call the adherence weans off to 85% at first follow up, 77% at third month and 53% at the end of year. By 52 weeks PSS had maximum adherence (78%) followed by SLE (58%), RA (42%) and SpA (42%). (Figure 1)Table 1.Comparison between pre and post interventionVariablesRAax-SpASLEPSS (N=64)(N=116)(N= 72)(N=71)Before intervention3.52.534•Median duration of diagnosis (years)2593419•Number of adherence (87)9473•Insight about the disease conditions17171616a.I don’t have disease30171631b.I have disease due to external factors28232511c.I have disease due to internal factors221173d.‘c’ + I need medication for some time<12<12e.‘c’ + I need medication per rheumatologist49304150After intervention5451•Median duration of diagnosis (weeks)9444•Number of adherence at 52 weeks (170)149811•Insight about the disease conditions31211711a.I don’t have disease57343732b.I have disease due to external factorsc.I have disease due to internal factord.‘c’ + I need medication for some timee.‘c’ + I need medication per rheumatologistFigure 1.Adherence proportion with consequent follow upConclusionEarly diagnosis, separate counselling sessions, effective control of symptoms and reminder to follow up significantly increases the adherence in rheumatological disorder.References[1]Safiri S, Kolahi A-A, Cross M, et al. Prevalence, deaths, and disability-adjusted life years due to musculoskeletal disorders for 195 countries and territories 1990–2017. Arthritis Rheumatol. 2021 Apr;73(4):702–714.gAcknowledgementsI would like to acknowledge Dr Sanjay Geed medical superintendent Medanta Superspeciality Hospital IndoreDisclosure of InterestsNone declared