Gaud-Listrat V, Lopez-Medina C, Hudry C, Nguyen M, Lebrun-Foisnet A, Sacchi A, Labatide Alanore S, Dernis E, Le Devic P, Fechtenbaum J, Richard-Miceli C, Le Goux P, Dadoun S, Moltό A, Blanchais-Behr A, Neveu S, Benhamou M, Giraud B, Roux C, Dougados M;

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Che H¹, Etcheto A², Dernis E³, Nataf H⁴, Boumier P⁵, Breuillard P⁶, Durandin-Truffinet M⁷, Fechtenbaum J⁸, Gaud-Listrat V⁹, Giraud B¹⁰, Hudry C¹¹, Labatide-Alanore S¹², Le Devic P¹³, Le Goux P¹⁴, Lebrun A¹¹, Maheu E¹⁵, Moura B¹¹, Nguyen M¹⁶, Sacchi A¹⁷, Ayral X², Blanchais A², Neveu S², Dougados M¹⁸, Moltó A¹⁸.

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Abstract

OBJECTIVES

Nowadays, the recommended measures for optimal monitoring of axial Spondyloarthritis (ax-SpA) disease activity are either BASDAI and CRP, or ASDAS-CRP. However, there could be a gap between recommendations and daily practice. We aimed to determine the measures collected by rheumatologists in an ax-SpA follow-up visit, and to determine the impact of a meeting (where rheumatologists reached a consensus on the measures to be collected) on the collection of such measures.

METHODS

A consensual meeting of a local network of 32 rheumatologists proposed, four months later, to report at least the BASDAI score in the medical file of every ax-SpA patient at every follow-up visit. An independent investigator reviewed the medical files of 10 consecutive patients per rheumatologist, seen twice during the year (e.g. before and after the meeting). The most frequently collected measures were assessed, and then, the frequency of collection before and after the meeting was compared.

RESULTS

A total of 456 medical files from 228 patients were reviewed. Treatment (>60%), CRP (51.3%) and total BASDAI (28.5%) were the most reported measures in medical files. Before/After the meeting, the frequencies of collected measures in medical files were 28.5%/51.7%, 51.3%/52.2%, 16.7%/31.6% and 0.9%/6.1% for BASDAI, CRP, BASDAI + CRP and ASDAS, respectively reaching a statistically significance for BASDAI, ASDAS and BASDAI+CRP (p<0.05).

CONCLUSIONS

This study revealed a low rate of systematic report of the recommended outcome measures in ax-SpA. However, it suggests that a consensual meeting involving practicing rheumatologists might be relevant to improve the implementation of such recommendations.

Gossec L¹, Salejan F, Nataf H, Nguyen M, Gaud-Listrat V, Hudry C, Breuillard P, Dernis E, Boumier P, Durandin-Truffinet M, Fannius J, Fechtenbaum J, Izou-Fouillot MA, Labatide-Alanore S, Lebrun A, LeDevic P, LeGoux P, Sacchi A, Salliot C, Sparsa L, d’André FL, Dougados M; RHEVER Rheumatology Network.

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Abstract

OBJECTIVE

An annual assessment of cardiovascular (CV) risk factors in rheumatoid arthritis (RA) is recommended, but its practical modalities have not been determined. The objective was to assess the feasibility and usefulness of a standardized CV risk assessment in RA, performed by rheumatologists during outpatient clinics.

METHODS

We used a cross-sectional design within a network of rheumatologists. Each rheumatologist included 5 consecutive unselected patients with definite RA. Data collection included standardized assessment of CV risk factors: blood pressure, interpretation of glycemia and of lipid levels, and calculation of the Framingham CV risk score. Outcome criteria included feasibility (missing data and time taken to assess the patients) and usefulness (the CV risk assessment was considered useful if at least 1 modifiable and previously unknown CV risk factor was evidenced).

RESULTS

Twenty-two rheumatologists (77% in office-based practice) assessed 110 RA patients. The mean ± SD age was 57 ± 10 years, and the mean ± SD RA duration was 11 ± 9 years; 50 patients (45%) were treated with biologic agents, and 76% were women. Regarding feasibility, missing data were most frequent for glycemia (27% of patients) and cholesterolemia (14% of patients). The mean ± SD duration of the CV risk assessment was 15 ± 5 minutes. The CV risk assessment was considered useful in 33 patients (30%), evidencing dyslipidemia (15% of patients) or high blood pressure (9% of patients) as the most frequently previously unknown CV risk factor.

CONCLUSION

The assessment of CV risk factors is feasible, but labor intensive, during an outpatient rheumatology clinic. This assessment identified modifiable CV risk factors in 30% of the patients. These results suggest that RA patients are not sufficiently assessed and treated for CV risk factors.

Fechtenbaum J¹, Gossec L, Nataf H, Boumier P, Breuillard P, Gaud Listrat V, Giraud B, Hudry C, Lecoq D’Andre F, Izou Fouillot MA, Maheu E, Nguyen M, Simonnet J, Dougados M; Medical Network RHEVER.

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Abstract

OBJECTIVE

Professional Practice Assessment (PPA) has become an obligation for all physicians in France, however its modalities remain unclear. The objective of this work was to evaluate the feasibility and accuracy of a PPA for private practice rheumatologists performed in the context of a network.

METHODS

A list of items considered mandatory to collect during an outpatient visit for rheumatoid arthritis, was prepared by the network. Non hospital-based rheumatologists, members of the network then evaluated some of their patient files selected by chronological order over a one-month period of time using this list. These files were then assessed by another private rheumatologist, member of the group, randomly allocated, using the same list of items.

RESULTS

Eighty percent of the private-practice doctors accepted to participate. The mean time to evaluate 15 patient files was 2 hours. Agreement between auto-evaluation and external evaluation for each file was good (agreement statistic, 0.75-1.0). Items mandatory to collect were collected in a high proportion of cases (84.6%).

CONCLUSION

PPA can be performed in the context of a network, auto-evaluation is a valid method and when the list of items is decided on by the network, the data are collected satisfactorily.

Fechtenbaum J¹, Lecoq d’André F, Nataf H, Hudry C, Listrat VG, Roux C, Dougados M; RHEVER Network (réseau hôpital et ville en rhumatologie).

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Abstract

OBJECTIVES

High-quality medical records that contain detailed data on the patient and disease are essential to high-quality patient care. RHEVER is a network of hospital- and office-based rheumatologists created in 1999 to pursue a number of objectives, including the development of recommendations about items that should be recorded routinely at each patient visit. Subsequently, one of the RHEVER members investigated whether these recommendations were followed by RHEVER participants at a teaching hospital.

METHODS

A cross-section of paper-based outpatient files at the rheumatology clinic of the Cochin Teaching Hospital, Paris, France, was studied. The sample comprised 50 files taken at random and 30 files of patients with rheumatoid arthritis.

RESULTS

In the 50 unselected files, the reason for the visit was consistently provided, but the diagnosis was variably recorded and decisions about investigations and treatments were not always described. Of the 30 files in patients with rheumatoid arthritis, 75% contained the full set of recommended clinical items.

CONCLUSION

This pilot study establishes the feasibility of practice pattern evaluation by rheumatologists. A similar study should be conducted among office-based RHEVER participants. Follow-up investigations are needed to evaluate the impact of medical record evaluations on quality of care.