Impact of a structured patient education programme on early diagnosis of prosthetic pulmonary valve endocarditis

Background: Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes. Methods: A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme. Results: Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset of symptoms and diagnosis of infective endocarditis was 6 days (range: 0–133 days) with a significantly longer delay among patients in cohort 1, compared to cohort 2 (25 days, range: 5–133 days versus 3 days, range: 0–13 days, p < 0.0001). A delay of >7 days was documented in 11/13 patients (85%) in cohort 1 as compared to 1/13 (8%) in cohort 2 (p < 0.001). Need for urgent valve replacement or permanent deterioration of prosthetic valve function was higher in cohort 1, compared to cohort 2 (11/13, 85% versus 5/13, 39%; p = 0.041). Conclusions: Prosthetic pulmonary valve endocarditis is increasingly recognised. A structured patient education programme may improve early diagnosis and clinical outcomes.

Concordance between clinician- and 2016 criteria-based diagnoses of fibromyalgia

Objectives The Fibromyalgia Survey Diagnostic Criteria-2016 (FSD-2016 criteria) were recently recommended for both clinical and research purposes. The present study aims to examine whether there is concordance between clinician-based and FSD-2016 criteria-based diagnoses of FM, and secondly, to examine how the illness severity and physical function relate to the criteria-based diagnosis among patients referred to a rheumatism hospital. Methods Participants with a clinician-based diagnosis of FM were included consecutively when referred to a patient education programme for patients with FM. Illness severity was assessed with the Fibromyalgia Survey Questionnaire (FSQ). Based on the FSQ, the fulfilment of the FSD-2016 criteria was evaluated. Physical function was assessed using the Fibromyalgia Impact Questionnaire (FIQ) function scale and self-reported employment status. Results The sample included 130 patients (84% women) from 20 to 66 years of age. Eighty-nine per cent met the FSD-2016 criteria, and 44% of the patients were fully or partially employed. Great variability in illness severity was seen irrespective of employment status. There was an association between illness severity and physical function (r=0.4, p<0.001). For 95% of the patients, the FSQ illness severity scores classify as severe or very severe, and even for those not fulfilling the diagnostic criteria the scores were moderate and severe. Conclusions There was relatively high agreement between clinician- and criteria-based diagnoses. The illness severity overlapped irrespective of different employment status and fulfilment of FSD-2016 criteria.

Patients use fewer analgesics following supervised exercise therapy and patient education: an observational study of 16 499 patients with knee or hip osteoarthritis

ObjectivesTo investigate changes in analgesic use before and after supervised exercise therapy and patient education in patients with knee or hip osteoarthritis (OA).MethodsWe recruited 16 499 of 25 933 eligible patients (64%; mean age 64.9; SD 9.6; 73% women) from the Good Life with osteoArthritis in Denmark (GLA:D) registry. Change in proportions of analgesic users (categorised according to analgesic risk profile; opioids > non-steroidal anti-inflammatory drugs > paracetamol) was assessed from before to after an 8-week supervised exercise therapy and patient education programme targeting knee or hip OA pain and functional limitations.ResultsPatients reported 13.2 mm (95% CI 12.8 to 13.6) less pain (visual analogue scale 0–100 mm) at follow-up compared with baseline. The proportion of analgesic users reduced from 62.2% (95% CI 61.5 to 63.0) at baseline to 44.1% (95% CI 43.3 to 44.9) at follow-up (absolute change: 18.1% (95% CI 17.3 to 19.0)). Among patients using analgesics at baseline, 52% changed to a lower risk analgesic or discontinued analgesic use. The proportion of opioid users after the exercise therapy was 2.5% (95% CI 2.1 to 2.9) lower than baseline; this represents a relative reduction of 36%.ConclusionAmong patients with knee or hip OA using analgesics, more than half either discontinued analgesic use or shifted to lower risk analgesics following an 8-week structured exercise therapy and patient education programme (GLA:D). These data encourage randomised controlled trial evaluation of whether supervised exercise therapy, combined with patient education, can reduce analgesic use, including opioids, among patients with knee and hip OA pain.

OP0308-PARE PREGNANCY AND ARTHRITIS - A PATIENT EDUCATION PROGRAMME IN IRELAND

Background:The relationship between pregnancy and arthritis is a complex one. Because of the variability of arthritic conditions, it is important for patients to get advice from their doctor or a specialist nurse before trying for a baby. There can be implications for medication regimes, while the pregnancy itself can also affect the inflammatory arthritis. In the postpartum period, other considerations include breastfeeding and the frequent return of flares.Through this education programme, Arthritis Ireland developed information resources primarily targeting women of child-bearing age. The multichannel campaign provided information about the wide range of issues of concern to women with inflammatory arthritis who are planning a family or are pregnant.Objectives:•To provide information and increase awareness around inflammatory arthritis and pregnancy;•To support women living with inflammatory arthritis through their illness and life journey;•To increase awareness of the work of Arthritis Ireland as a patient organisation.Methods:In developing and executing this education programme, Arthritis Ireland worked extensively with a team of healthcare professionals, who are regarded internationally as leaders in this field.A multi-channel approach was taken to the development, production and dissemination of information, with public information events, literature and a suite of videos developedUp to this point, there had not been any Irish-produced material on this subject. he topic was seen to be an important one and an issue of significant public health interest.The series of information talks on pregnancy and inflammatory arthritis was delivered by consultant rheumatologists and were held in cities around Ireland. The information booklet covered topics such as planning for a baby, medication and pregnancy, the role of the father, fertility, genetics, during the pregnancy, after the pregnancy and breastfeeding.Video was seen to be central to the success of the campaign. Working with the expert healthcare team, six information videos were developed around obstetrics, rheumatology, physiotherapy and occupational therapy. The videos were published and promoted across Arthritis Ireland’s social media channels and website.The capstone video featured a young mother who was diagnosed with JIA when she was two. Her story was an incredibly powerful testimony of overcoming and dealing with adversity and complex health issues.Results:This educational campaign was developed to meet a significant need in the health information landscape. While there are no little resources produced focusing on pregnancy and parenting, there wasn’t anything in Ireland which specifically addressed the needs of women and men with inflammatory arthritis who are looking to have a family. The materials produced are a valuable part of Arthritis Ireland’s canon of patient education materials.Conclusion:It is anticipated that the materials developed will have a long lifespan and will support prospective parents for several years to come. Central to the success of the project was the involvement of the expert healthcare teams. Their commitment to the project spoke volumes of its importance and the considerable need for the clearly communicated information, which the project provided.Ultimately, Arthritis Ireland has produced a suite of resources which will be referenced and used by patients, and will hopefully make a considerable impact on their quality of life.Acknowledgments:This patient education programme was supported by a grant from UCB.Disclosure of Interests:Brian Lynch Grant/research support from: Arthritis Ireland received a grant from MSD to develop this patient education programme. Brian Lynch has not benefited personally in any way.

How does a new patient education programme for renal recipients become situated and adapted when implemented in the daily teaching practice in a university hospital? An ethnographic observation study

ObjectiveTo understand how a new patient education programme for renal recipients becomes situated and adapted when implemented in daily hospital teaching practice. The analysis focuses in particular on how principles of individual tailoring and patient involvement are adapted.DesignEthnographic observation study. 19 teaching sessions were observed, resulting in 35 pages of data written observation notes.SettingA Norwegian University hospital. The study included the transplantation (TX) post, the medical post and the outpatient clinic.Participants10 newly transplanted patients receiving the education programme, and 13 nurses trained in the new programme participated in the study.ResultsWe observed that the nurses attempted to implement the programme’s core principles of individual tailoring and patient involvement as intended, but that patients found it difficult to formulate their knowledge needs and interest. Patients and nurses developed an approach to individual tailoring and patient involvement, which used knowledge about the patients’ life and experiences as basis for translating generalised knowledge into knowledge that is individualised and meaningful for the patient. The individual tailoring was however also limited, as the nurses balanced between responsibilities for the programme’s principles of individual adaption and patient involvement at the one hand, and responsibilities of safety and economy from a health systems perspective on the other hand.ConclusionIndividual tailoring is observed to be a comprehensive practice which includes verbal, practical and emotional involvement with the patient’s life world. This extends the notion and practice of individual tailoring as selecting among predefined, generalised knowledge based on an initial mapping of the patients’ knowledge. While the adaptions to individual tailoring could have been seen as inaccurate implementation, in-depth analyses discloses that the extended approach to individual tailoring is in fact what retains the programme’s core principles in the implementation context.

Effect of a participatory patient education programme (NExt EDucation) in group-based patient education among Danes with type 2 diabetes

Objective To assess the effect of a participatory group-based education programme for individuals with type 2 diabetes, Next Education. Method In a quasi-experimental study, individuals with type 2 diabetes were recruited from 14 Danish municipalities with a patient education programme. Eight municipalities using Next Education were intervention sites; six control sites used usual group-based education programmes. Data were collected through questionnaires at baseline and at 3 and 12 months after programmes ended. Changes in quality of life (EQ-5D-5L), diabetes-related emotional distress (PAID-5), physical activity, diet, foot care and sense of coherence (SOC-13) were assessed in generalised linear mixed models. Results At baseline, 310 participants (52.6% females, mean age 62.5 years [SD = 10.7] and a mean duration of type 2 diabetes of 6.9 years [SD = 8.4]) participated in Next Education ( n = 234) or group-based education ( n = 76) at control sites. Compared with participants at control sites, participants at intervention sites had significantly larger sense of coherence scores at 3 (9.4%, p = 0.03) and 12 (9.8%, p = 0.02) months of follow-up. Other measures did not differ significantly between groups. Discussion It is likely that person-centeredness and high degrees of user participation at the intervention sites improved sense of coherence among Danes with type 2 diabetes.