Nurse-led education prevents adverse effects in rheumatoid arthritis, SpA treatment
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Nurse-led education for patients with rheumatoid arthritis or spondyloarthritis, who are beginning biologic disease-modifying antirheumatic drugs, is effective at changing behaviors to prevent adverse events, according to data.
“Biologic disease-modifying antirheumatic drugs (bDMARDs) are effective treatments for inflammatory arthritis but can lead to safety issues, which could be prevented by educating patients,” Catherine Beauvais, MD, of Saint Antoine Hospital, in Paris, and colleagues wrote in RMD Open. “Recommendations regarding safety exist for health professionals, such as vaccinations or dealing with situations at risk, but educating patients on safety matters has not been evaluated in controlled trials.”
To examine the impact of nurse-led education on safety skills in patients with inflammatory arthritis, Beauvais and colleagues conducted a multicenter, open-label, randomized control trial of individuals with RA or SpA. In the intervention group, patients received face-to-face education with a nurse at the point of their first dose of subcutaneous biologic DMARD therapy, with a follow-up at 3 months. Meanwhile, the control group received usual care.
Enrollment occurred between January 2017 and April 2018, and the final follow-up was conducted on Nov. 27, 2018. Patients were included if they were between the ages of 18 and 75 years, had a confirmed diagnosis of RA or SpA, and were naïve, but eligible, for subcutaneous biologic DMARD therapy. The primary outcome was the BioSecure questionnaire, assessed at 6 months. Higher scores on the survey correlated to higher safety skills among the patients, the authors wrote. Secondary outcomes, which included disease activity and coping and physiological well-being measurements, were assessed at 6 months.
A total of 122 participants were included in the study, with 64 in the intervention group and 63 receiving usual care.
According to the researchers, the BioSecure measurement in the intervention group was 81.2 ±13.1, compared with 75.6±13 in the control group (difference = 6.2; 95% CI, 1.3-11.1). Patients who received nurse-led education demonstrated stronger skills at handling infections, more willingness to receive vaccinations and closer adhesion to prescribed behaviors. Coping skills also improved in the patients who underwent the intervention, the authors wrote.
“This randomized trial represents a significant advance in the field of safety management by showing a beneficial effect of a nurse-led intervention to increase patients’ safety skills related to bDMARDs,” Beauvais and colleagues wrote. “Hence, delivering a patient education session may be useful to patients starting a first bDMARD. Other studies will be necessary to assess whether the rate of severe adverse events is lowered by such an intervention.”
Perspective
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Patient education is the heart and soul of rheumatology nursing, and the results of the trial conducted by Beauvais, et al. further demonstrate the value of the nurse in the management of patients with inflammatory arthritis.
Starting on biologic therapy can be overwhelming for patients, and with limited time dedicated to education during office visits, patients are often left with more questions than answers. Although patients may be given a handout regarding the prescribed therapy that includes notifying the provider of any infections, surgeries, etc., I find the patient often doesn't understand the reasoning behind these interruptions in therapy or the importance of reporting this information.
Now that there is evidence-based research that demonstrates the efficacy of nurse-led patient education programs, specifically regarding safety and adherence, my hope would be that we start to see these programs implemented into rheumatology practices.
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