Efficacy of a nurse-led patient education intervention in promoting safety skills of patients with inflammatory arthritis treated with biologics: a multicentre randomised clinical trial

Objective

To evaluate the effect of a nurse-led patient education on safety skills of patients with inflammatory arthritis treated with biologic disease-modifying antirheumatic drugs (bDMARDs).

Methods

This is a multicentre, open-labelled, randomised controlled trial comparing an intervention group (face-to-face education by a nurse at baseline and 3 months later) with a control group (usual care) at the introduction of a first subcutaneous bDMARD. The primary outcome was score on the BioSecure questionnaire at 6 months (0–100 scale), a validated questionnaire assessing competencies in dealing with fever, infections, vaccination and daily situations. The secondary outcomes were disease activity, coping, psychological well-being, beliefs about medication, self-efficacy and severe infection rate.

Results

129 patients with rheumatoid arthritis and spondyloarthritis were enrolled in nine rheumatology departments; 122 completed the study; 127 were analysed; and 64 received the intervention (mean duration: 65 min at baseline and 44 min at 3 months). The primary outcome was met: the BioSecure score was 81.2±13.1 and 75.6±13.0 in the education and usual care groups (difference: +6.2, 95% CI 1.3 to 11.1, p=0.015), demonstrating higher safety skills in the education group. Exploratory analyses showed better skills regarding infections, greater willingness for vaccinations and greater adherence-related behaviours in the education group. Coping was significantly more improved by education; other secondary outcomes were improved in both groups, with no difference.

Conclusions

Educating patients was effective in promoting patient behaviours for preventing adverse events with bDMARDs. An education session delivered to patients starting a first bDMARD can be useful to help them self-manage safety issues.

Trial registration number

NCT02855320.

[How health care professionals perceive chronic disease: Changes in therapeutic patient education (TPE) assessment from 2011 to 2017 in a French university hospital]

BACKGROUND

Since 2010, in France, Therapeutic Patient Education (TPE) programs have applied to the Regional Health Agency (RHA) for authorization. Every four years, these programs are mandatorily re-evaluated, and the assessment allows for change in the program management criteria. In our hospital, we studied the evolution of the Therapeutic Patient Education (TPE) appraisal benchmarks, otherwise known as "indicators", in the 17 programs having been authorized and renewed at least once by the RHA.

METHOD

The TPE program appraisal benchmarks are classified in terms of structure, process and outcomes; program activity itself as well as pedagogic, psychosocial and bioclinical indicators are taken into consideration. We wished to determine the extent to which these indicators were addressed, applied and renewed or created during renewal of the TPE programs. Statistical tests were carried out in order to compare changes in the number of benchmarks in each category before and after the renewal process.

RESULTS

During the first authorization, there existed 533 appraisal benchmarks, while they numbered 550 for the second. As for "before-and-after" changes, they consisted in a reduced number of outcome indicators (43.7% to 35.1%), whereas process indicators increased (36.8% to 43.1%) (P=0.0141). In comparison to the category pertaining to pedagogic, psychosocial and bioclinical indicators, the most widely registered indicator category (55.5%) and the most frequently collected indicator category involved the program activity itself (54.7%) (P<0.0001), which increased pronouncedly during renewal periods (67.6%) (P=0.0002). Conversely, the pedagogic and psychosocial indicators were little if at all collected. As regards the latter, there was nevertheless a considerable increase in indicators related to skills and changes favoring health-promoting behaviours. Strictly bioclinical indicators have been largely supplanted by those having to do with the disease evolution, its impact and risk management.

CONCLUSION

The major role assigned to process and structure indicators reflects the fact that they are predominantly structured by RHA requests. Even if this initial study necessitates further research, it highlights a change in the design of educational and psychosocial assessments among caregivers, a change likely to reflect their interest in how patients go about managing their illnesses, (more or less healthy) lifestyles and daily lives.