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.

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 2021;50(4):701-708

PMID: 32521324

Full Text on Elsevier Science View on PubMed

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.

Address: Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France. Electronic address: [email protected].; Sorbonne Université, IPLESP, INSERM, Paris France; Pitié Salpêtrière hospital, APHP, Rheumatology department, Paris, France.; Rehabilitation and Physical Medicine Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.; Rheumatology Department, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, and Université Paris Est Créteil, EA, 7379 - EpidermE, F-94010, Créteil, France.; Rheumatology Department, CHU Clermont-Ferrand, Clermont-Ferrand, France.; Rheumatology Department, CHRU de BESANCON, University Teaching Hospital, and Université Bourgogne Franche-Comté, EA4266 (EPILAB), Besançon, France.; Rheumatology Department, CHU Grenoble, France.; Rheumatology Department, CH Le Mans, France.; Rheumatology Department, CHU Marseille, France.; Rheumatology Department, CHU Rouen, France.; Centre de Rhumatologie, Hôpital Purpan, Toulouse, et Faculté de Médecine, Université Toulouse III, Paul Sabatier University, Toulouse, France.; Medecine Faculty, Department of Rheumatology, South Hospital, Rennes 1 University, Rennes, France.; Rheumatology Department, APHP, Bicêtre Hospital, Le Kremlin-Bicetre, France.; Rheumatology Department, Saint Antoine Hospital, APHP, Paris, France.; Rheumatology department, CHU Montpellier, Montpellier University, Montpellier, France.; Rheumatology Department, CHU Roger Salengro Hospital, University of Lille, Lille, France.; Université Paris Diderot, UFR médicale, Paris, France; APHP Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, France.; Department of Rheumatology, Nancy Hospital, Nancy, France.; Rheumatology Unit, UMR1227 (Lymphocytes B et Autoimmunité), Université de Brest, Inserm, CHU Brest, LabEx IGO, Brest, France.; Department of Rheumatology, Hautepierre CHU, Fédération de médecine translationnelle, UMR INSERM 1109, Strasbourg, France.; Rheumatology Department, Pellegrin Hospital, Bordeaux, France.; Rheumatology Department, Cochin Hospital, Assistance Publique Hôpitaux de Paris, Paris, France; Université de Paris, INSERM U-1153, CRESS, Paris, France.

DOI: 10.1016/j.semarthrit.2020.05.012

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MeSH Terms: Adult, Comorbidity, Female, Humans, Male, Mass Screening, Middle Aged, Patient Acceptance of Health Care, Practice Patterns, Nurses', Prospective Studies, Self-Management, Spondylitis, Ankylosing