Patients with Inflammatory Arthritis (IA) often experience difficulties in daily life as a result of their disease. Unfortunately, outpatient consultations in daily practice tend to focus on medical topics, thereby ignoring the impact of the disease on patients’ daily lives. Patient-Reported Outcomes (PROs) can be used to understand this impact, but they are not enough for offering person-centered care. Because the patient’s true values and goals can only be ascertained during a proper conversation, which should include both medical as well as patient goals. Therefore, the aim of the study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in IA patients. IA patients with an active disease were given the opportunity to set and follow-up goals. In addition to goal setting, patients were asked to complete online questionnaires on various PROs, including HRQoL. Ninety-two IA patients participated in the study. The mean age was 51 years and most of them had rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. In the entire population, HRQoL did not change over time, but patients who did not meet their goals tended to report a lower HRQoL. Incorporating a feedback mechanism in a goal-setting strategy has a positive effect on goal attainment. Yet no effect was seen on HRQoL, but this may due to the fact that general HRQoL measurement are not sensitive or specific enough to detect changes that are accompanied with goal setting and attainment.

Background: Health care is shifting toward a person-centered care (PCC) approach. For implementation of PCC, there may be a special role for nurse practitioners (NPs).Purpose: The aim of this study was to explore the patient-perceived levels of and needs for of PCC in inflammatory arthritis patients who visited the NP at the outpatient clinic of an academic hospital in the Netherlands.Methods: A cross-sectional study was performed. Disease characteristics were inventoried from the patient records. Patients filled out the PCCoc/rheum instrument, an instrument to measure patient perceived PCC, and a questionnaire based on the 14 life areas of the Self-Management Web, extended with areas including pain, fatigue, and night's rest. Participants were asked which life areas caused problems, and whether these problems were discussed. Mean values were calculated for normally distributed data and medians for nonnormally distributed data.Results: Most of the patients had well-controlled disease (86.1%). The mean score of the PCCoc/rheum was 55.3 (SD 8.1). Patients experienced most problems in life areas fatigue (37.3%) and pain (35.3%), these were also the life areas that were most often addressed at consultation. The life areas that gave problems and that were least addressed during consultation were intimate relationships & sexuality (66.7%) and household chores (58.8%).Conclusions: Despite an overall high level of patient perceived PCC delivered by NPs, patient with low disease activity frequently reported problems in life areas not addressed at consultation. Implications for practice: Implementation of the Self-Management Web and changing the focus of NP consultations may help to improve accommodating individual patient needs.

BackgroundHealthcare is increasingly shifting towards a person-centered care(PCC) approach. Unfortunately, in daily practice, outpatient consultations focus mainly on medical topics, ignoring the impact of the disease on daily life. To understand the impact on patients’ daily lives, Patient Reported Outcomes(PROs) can be used. However, it is not enough to only use PROs when offering PCC, because the patient’s true values and goals can only be ascertained during a good conversation, in which both medical and patient goals should be addressed.ObjectivesThe aim of this study is to evaluate the effect of a goal management strategy with integrated feedback on goal attainment and Health-Related Quality of Life(HRQoL) in inflammatory arthritis(IA) patients. We also explored what type of goals were set.MethodsData were used from the Immune Mediate Inflammatory Disease(IMID) registry, a prospective cohort study in which IMID patients were followed with online PRO questionnaires. IA patients with active disease were asked to formulate up to 3 achievable goals within 3 months of follow-up. They could work independently on their goals. Every 2 weeks, patients received an automatically generated e-mail reminder asking them how well they had worked on their goals for the previous 2 weeks. After 3 and 6 months, it was evaluated whether the goals were achieved. If the goals were achieved after 3 months, new goals could be formulated for the next 3 months. Patients’ goals were classified into the 14 domains of the Self-management Web, extended with the domains pain and energy. At each visit (baseline, 3 and 6 months) patients also filled out online questionnaires on goal setting, shared decision making(SDM) and PROs. PRO questionnaires included HRQoL, patient satisfaction(VAS-PS), pain(VAS-pain), general health(VAS-GH) and daily functioning(HAQ). At baseline also a questionnaire on coping styles was filled out.ResultsNinety-two patients participated in the study. The mean age was 51 years and the most common diagnosis was rheumatoid arthritis. A total of 302 patient goals were set, of which 32% were achieved. Most goals were formulated in the domains lifestyle(14%), pain(13%) and symptoms & side-effects(13%). Fewer goals were formulated in the domains intimate relationships & sexuality(0.6%) and finances(0.3%). In the entire population, HRQoL, VAS-PS, VAS-pain, VAS-GH and HAQ scores did not change over time. However IA patients who did not achieve their goals tended to score worse on HRQoL, VAS-PS and HAQ after 6 months. In contrast, VAS-pain and VAS-GH showed no relation with goal attainment. The patients’ most common coping styles were active approach and comforting thoughts.ConclusionThis study has raised awareness off the importance of patients goal setting. However, the goal-setting process is time consuming and, therefore, health professionals should be trained in goal setting. An online support tool which can be used in preparation for an outpatient clinic visit, can circumvent aforementioned problems. An example of such a tool is the Self-management Web, which help patients organize and prioritize perceived problems in different domains and subsequently helps them to formulate their goals. As a result patients’ goals can be concretized immediately during the consultation, which can save time and, therefore, lower the threshold for implementation. Moreover, the incorporation of a feedback mechanism into a goal-setting intervention also seems to have a positive effect on goal attainment. Unfortunately, our intervention showed no effect on HRQoL. However, a general HRQoL measurement may not be sensitive or specific enough to detect change at this point. Possibly self-management and self-efficacy are better outcome measures. These may improve if patients actively address their problems in daily life, set goals to overcome them, and thereby better manage the disease. Therefore, we recommend using more specific outcomes, or qualitative assessment of outcomes, in goal setting studies.REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsKim van Slingerland: None declared, Pascal de Jong Grant/research support from: Lilly, Radboud Dolhain: None declared, Annelieke Pasma: None declared.