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AB1541-HPR (2022)
IMPACT OF COUNSELLING, TELEPHONE-BASED SYMPTOMS TREATMENT TITRATION AND REMINDER CALL ON REGULAR FOLLOW UP AMONG COMMON RHEUMATOLOGIC DISORDERS; A PROSPECTIVE COHORT STUDY
V. Kattel1, N. Gupta2, S. Malviya3
1BP Koirala Institute of Health Sciences, Internal Medicine, Dharan, Nepal
2MGM Medical College, Anaesthesiology, Indore, India
3Medanta Superspeciality Hospital, Rheumatology and Clinical Immunology, Indore, India

Background: Poor adherence to rheumatologic diseases exist for various reasons.


Objectives: The objective of the study was to measure adherence with interventions.


Methods: It 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.


Results: Among 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 )

Comparison between pre and post intervention

Variables RA ax-SpA SLE PSS (N=64)
(N=116) (N= 72) (N=71)
Before intervention 3.5 2.5 3 4
•Median duration of diagnosis (years) 25 9 34 19
•Number of adherence (87) 9 4 7 3
•Insight about the disease conditions 17 17 16 16
a.I don’t have disease 30 17 16 31
b.I have disease due to external factors 28 23 25 11
c.I have disease due to internal factors 22 11 7 3
d.‘c’ + I need medication for some time <1 2 <1 2
e.‘c’ + I need medication per rheumatologist 49 30 41 50
After intervention 5 4 5 1
•Median duration of diagnosis (weeks) 9 4 4 4
•Number of adherence at 52 weeks (170) 14 9 8 11
•Insight about the disease conditions 31 21 17 11
a.I don’t have disease 57 34 37 32
b.I have disease due to external factors
c.I have disease due to internal factor
d.‘c’ + I need medication for some time
e.‘c’ + I need medication per rheumatologist

Adherence proportion with consequent follow up


Conclusion: Early 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.g


Acknowledgements: I would like to acknowledge Dr Sanjay Geed medical superintendent Medanta Superspeciality Hospital Indore


Disclosure of Interests: None declared

Citation: , volume 81, supplement 1, year 2022, page 1872
Session: HPR Interventions (educational, physical, social and psychological) (Publication Only)