Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one year randomized trial.

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.

• Authors: Anna Molto, Laure Gossec, Serge Poiraudeau, Pascal Claudepierre, Martin Soubrier, Françoise Fayet, Daniel Wendling, Philippe Gaudin, Emmanuelle Dernis, Sandrine Guis, Sophie Pouplin, Adeline Ruyssen, Gerard Chales, Xavier Mariette, Catherine Beauvais, Bernard Combe, René-Marc Flipo, Pascal Richette, Isabelle Chary-Valckenaere, Alain Saraux, Jean Sibilia, Thierry Schaeverbeke, Maxime Dougados
• Journal: Seminars in arthritis and rheumatism (Semin Arthritis Rheum) Vol. 50 Issue 4 Pg. 701-708 (08 2020) ISSN: 1532-866X [Electronic] United States
• PMID: 32521324 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2020 Elsevier Inc. All rights reserved.

Topics

• Adult
• Comorbidity
• Female
• Humans
• Male
• Mass Screening (methods)
• Middle Aged
• Patient Acceptance of Health Care (statistics & numerical data)
• Practice Patterns, Nurses' (organization & administration)
• Prospective Studies
• Self-Management
• Spondylitis, Ankylosing (nursing)