LAUSR

Background : In 2011 ILAR supported a pilot project in training a rheumatologist in an underserved area in Macedonia. The pilot took place in the clinical centre of Bitola. Previously, rheumatologic care was provided by visiting rheumatologists from the rheumatology clinic in the capital city.1 Objectives The primary goal of this project was to pilot a model in rheumatologic training and improve rheumatologic care in an underserved area in Macedonia. Methods An internist from the clinical centre in Bitola was enrolled in a two-year training by the Rheumatology clinic at Ss Cyril and Methodius University in Macedonia, and the rheumatology division at the University of Michigan. Pre intervention metrics of quality of care as measured by access, standard therapy, and DAS 28 scores were compared with post intervention metrics. Results The primary goal of the project enabled training of a rheumatologist. A local internist completed her training in rheumatology (2014), and established a rheumatology clinic within the clinical centre in the city of Bitola in 2014, providing daily access to patients with rheumatic conditions in a region with a population of 3 00 000. Patient access changed from 120 visits/month to 800 visits/month. The service provided consultations to hospitalised patients. The secondary endpoints: quality of care as measured by standard therapy for rheumatoid arthritis and DAS-28 scores are as shown on table 1.Abstract AB1254 – Table 1 Rheumatoid Arthritis patients Pre-intervention 2011 (n=115) Post-intervention 2017 (n=86) Statistical Significance Patients taking methotrexate 44% 53% Methotrexate dose 11.5 mg (10–15 mg) 13.9 mg (10–25 mg) p<0.00001 Combination therapy* 39% 38.5% NS Dual therapy* 31% 35% NS Triple therapy* 3.5% 5% NS DAS-28 average 4.8 4.41 NS MTX=methotrexate; *methotrexate, sulfasalazine, leflunomide, antimalarial (chloroquine, hydroxychloroquine) Post intervention, more patients were taking methotrexate and at higher doses. Despite this trend, its average dose was less than 50% of its maximal dose (25 mg/week) commonly used in standard practice. The frequency of combination therapy remained unchanged. Likewise, no significant change in the DAS-28 scored was observed. Conclusions Prior to launching the pilot, the rheumatologic care in this region was provided by visiting rheumatologists from the university clinic in the capital city. Initial assessment pointed to several obstacles: poor access and substandard therapy that likely contributed to the prevalence of high disease activities. Our pilot succeeded in training a rheumatologist, thus reaching our primary goal of improving local access to rheumatic care. The secondary goals of improving the quality of care as measured by the DAS-28, standard of therapy for rheumatoid arthritis- reflected by appropriate use of DMARDS (use of methotrexate, combination therapy) showed a modest improvement While higher doses of methotrexate were use, combination therapy and better control of rheumatoid arthritis (DAS-28) remained unchanged, thus posing a challenge for ongoing need and future intervention goals. Reference [1] Ognenovski, VM, Arsovska- Nalbanti, M, Chichikj D, Calovski, J. Improving care and education in the Republic of Macedonia: model for rheumatologic education and care in a developing country—ILAR Initiative. Clin Rheumatol2013Nov;32(11):1669–71 Disclosure of Interest None declared