AB1146 PHYSICIAN ADHERENCE TO CLINICAL GUIDELINES IN RHEUMATOLOGY: CAN IT HELP PROVIDING EVIDENCE-BASED, STANDARDIZED CLINICAL DECISIONS

• Published in: Annals of the rheumatic diseases Vol. 82; no. Suppl 1; p. 1803
• Main Authors: Y El Miedany, Kamel, N, Abu-Zaid, M H, Abdel-Nasser, A, Mortada, M A, Hassan, W, Mahran, S A, Sayed, H, R Abdel Khalek, Fouad, N, Tabra, S A A, Elwakil, W, Saber, S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.06.2023
• Subjects: Clinical medicine; Clinical practice guidelines; Decision making; Psoriatic arthritis; Rheumatoid arthritis; Rheumatology; Surveys; Visual thresholds; Egypt
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2023-eular.1090

BackgroundClinical practice guidelines serve many targets, including guiding clinical decision-making process based on best evidence, standardized patient care, improving provider performance, setting standards of practice, and reducing variability in practice. Despite their vital role in standard practice, adherence to guidelines has been reported to be suboptimal. Overall, no information is available of how rheumatologists would interact with recently published national clinical practice guidelines [1, 2].ObjectivesTo answer three principal research questions: (i) how far do rheumatologists deviate from the recommended clinical guidelines (ii) What are the major barriers to guidelines adherence? and (iii) What are the factors that would improve guideline adherence?MethodsThis was Cross sectional multi-center, survey-based study. Rheumatologists in 12-centers, covering both the north and south of Egypt, were invited to participate in the study. All outcomes were measured using a validated survey tool. The primary outcome of interest was barriers to guideline adherence. Secondary outcomes included general attitudes toward guidelines and factors that could improve adherence to guidelines. Outcomes were measured by the survey tool. All outcomes were reported on a numerical visual analogue scale (0-100). 55% was defined a priori as a threshold to infer strong association between physician responses and category of interest. P-value <0.05 was used for statistical significance.Results77 rheumatologists participated in the survey. Analysis of the participants experience revealed a broad range of knowledge with 18.2% were still in training (residents), 10.4% have 1-3 years of experience, 14.3% have 3-5 years’ experience, 24.7% have 5-10 years of experience whereas 32.5% had more than 10-years of experience. The majority 65% have not been ever involved in clinical guidelines development (p < 0.001). 74% agreed/ strongly agreed that they were adequately trained accessing and applying guidelines in their standard practice, whereas 6.5% only disagreed (p< 0.001). 58.4% rated their adherence to clinical practice guidelines as high/very high, whereas 38% rated it as average and 2.6% rated it as low (p< 0.01). In concordance, 88.3% of the participants voted that they do implement “Treat to Target” approach for the management in their standard practice (p< 0.001). Major barriers to guidelines adherence were time constrains due to clinical documents (53.2%), access to relevant guidelines at the point of care (48.1%) as well as lack of insurance cover of cost of some recommendations (72.7%). Factors that would improve guideline adherence included: improved focus on guidelines during training (88.3%), access to relevant guidelines at the point of care (87.4%)ConclusionGuidelines have enhanced physician adherence to management recommendations and provide evidence-based, standardized clinical decisions. Results of the work revealed significantly less tendency to deviate from the national guidelines among rheumatologists. Few areas of improvement have been identified including implementing the guidelines in trainee’s education courses and consistent access to relevant guidelines at the points of care.References[1]El Miedany Y. et al, Egyptian guidelines for the treatment of Rheumatoid Arthritis — 2022 update. Egypt Rheumatol Rehabil 2022; 49: 56.[2]El Miedany Y. et al. Psoriatic arthritis treatment to the target: a consensus, evidence-based clinical practice recommendations for the management of psoriatic arthritis and its concomitant clinical manifestations. Egypt Rheumatol Rehabil 2022; 49: 32.Acknowledgements:NIL.Disclosure of InterestsNone Declared.