Anna Molto1, Laure Gossec2, Serge Poiraudeau3, Pascal Claudepierre4, Martin Soubrier5, Françoise Fayet5, Daniel Wendling6, Philippe Gaudin7, Emmanuelle Dernis8, Sandrine Guis9, Sophie Pouplin10, Adeline Ruyssen11, Gerard Chales12, Xavier Mariette13, Catherine Beauvais14, Bernard Combe15, René-Marc Flipo16, Pascal Richette17, Isabelle Chary-Valckenaere18, Alain Saraux19, Jean Sibilia20, Thierry Schaeverbeke21, Maxime Dougados22. 1. Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France. Electronic address: anna.molto@aphp.fr. 2. Sorbonne Université, IPLESP, INSERM, Paris France; Pitié Salpêtrière hospital, APHP, Rheumatology department, Paris, France. 3. Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France. 4. Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France. 5. Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France. 6. Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France. 7. Rheumatology Department, CHU Grenoble, France. 8. Rheumatology Department, CH Le Mans, France. 9. Rheumatology Department, CHU Marseille, France. 10. Rheumatology Department, CHU Rouen, France. 11. Centre de Rhumatologie, Hôpital Purpan, Toulouse, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Toulouse, France. 12. Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France. 13. Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France. 14. Rheumatology Department, Saint Antoine Hospital, APHP, Paris, France. 15. Rheumatology department, CHU Montpellier, Montpellier University, Montpellier, France. 16. Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France. 17. Université Paris Diderot, UFR médicale, Paris, France; APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France. 18. Department of Rheumatology, Nancy Hospital, Nancy, France. 19. Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, France. 20. Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France. 21. Rheumatology Department, Pellegrin Hospital, Bordeaux, France. 22. Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France.
Abstract
OBJECTIVE: To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. METHODS: Prospective, randomized, controlled, open, 12-month trial (NCT02374749). PARTICIPANTS: consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). MAIN OUTCOME: change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). RESULTS:502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). CONCLUSIONS AND RELEVANCE: This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.
RCT Entities:
OBJECTIVE: To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. METHODS: Prospective, randomized, controlled, open, 12-month trial (NCT02374749). PARTICIPANTS: consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) THE PROGRAM: A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. TREATMENT ALLOCATION: random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). MAIN OUTCOME: change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). RESULTS: 502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). CONCLUSIONS AND RELEVANCE: This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.
Authors: Dietmar Krause; Anna Mai; Robin Denz; Johannes Johow; Jens-Peter Reese; Benjamin Westerhoff; Renate Klaaßen-Mielke; Nina Timmesfeld; Annette Rittstieg; Ertan Saracbasi-Zender; Judith Günzel; Claudia Klink; Elmar Schmitz; Claas Fendler; Wolf Raub; Stephanie Böddeker; Friedrich Dybowski; Georg Hübner; Hans-Jürgen Menne; Heinz-Jürgen Lakomek; Michael Sarholz; Ulrike Trampisch; Hans J Trampisch; Jürgen Braun Journal: Dtsch Arztebl Int Date: 2022-03-11 Impact factor: 8.251
Authors: Steven L Truong; Tim McEwan; Paul Bird; Irwin Lim; Nivene F Saad; Lionel Schachna; Andrew L Taylor; Philip C Robinson Journal: Rheumatol Ther Date: 2021-12-28