Patient organization challenges government to bring vital support to people with rheumatic diseases in Cyprus

The campaign presented today at the Annual European Congress of Rheumatology (EULAR 2019) reports how the Cyprus League Against Rheumatism (CYPLAR) successfully took on the Ministry of Health after authorisation was denied to introduce specialised rheumatology nurses due to a perceived lack of interest in rheumatology education.

In many countries, rheumatology has developed into a recognised nursing specialty where nurses undertake advanced and extended roles. While some countries have accepted that interventions undertaken by nurses are essential to effectively tackle the challenges of chronic illness in an integrated fashion, this concept has not been widely adopted across Europe.

"We are determined to challenge the government in Cyprus to implement a rheumatology nurse service into the health system," said Ms Andri Phoka Charalambous, Patient Expert General Secretary of the Cyprus League Against Rheumatism, Cyprus. "We're proud to have achieved a significant step towards our goal with the successful implementation of the first rheumatology nurse educational program in Cyprus."

After many meetings with the Government Nursing Services demonstrating the value of rheumatology nurses, the officers became very excited about the development of a new "Patient Care with Rheumatic Diseases" educational programme. CYPLAR were instrumental stakeholders in both the design and delivery of the program which was provided to 27 nurses at the end of 2018. Following the training a survey of the participants demonstrated very encouraging results. When asked, "after training will you be interested in working as a rheumatology nurse in a rheumatology clinic?", they were delighted to announce that 100% answered yes.

"We highly commend the work of the Cyprus League Against Rheumatism to bring the vital support of rheumatology nurses to people living with rheumatic and musculoskeletal diseases," said Professor Thomas Dörner, Chairperson of the Scientific Programme Committee, EULAR. "We hope this project acts as an inspiration to others involved in supporting the work of nurses specialising in rheumatology to make a difference in patients' lives."

The "Patient Care with Rheumatic Diseases" educational programme was conducted one day per week over three months, with several lectures being delivered by CYPLAR. There were three days of clinical experience in an outpatient Rheumatology Clinic and one day in the Care Department gaining experience in the preparation and delivery of biological and biosimilar therapeutics. Examination consisted of a final written evaluation (60%) and a case study presentation.

The significance of this campaign is supported by the results of a randomised controlled trial, also presented today at EULAR 2019, which demonstrates that nurse-led patient education can significantly improve essential safety skills in patients with inflammatory arthritis.

Results of the study show that, at six months, the 'intervention group' had significantly higher acquisition of safety skills compared to the 'usual care' group with a Biosecure score of 81.2+13.1 versus 75.6+13.0 respectively (p=0.016).

"Safety is an important issue in the management of inflammatory arthritis treated with biologic disease-modifying antirheumatic drugs," said Catherine Beauvais MD, University Hospital Saint Antoine, Paris, France. "We hope our results provide evidence to support the implementation of nurse-led patient education programs in centres across Europe."

The study included 120 patients with rheumatoid arthritis, axial spondyloarthritis or peripheral spondyloarthritis at the time of their first introduction of a biologic disease-modifying antirheumatic drug (bDMARD). Patients were randomised to receive 'usual care' or 'intervention care' which was a face-to-face nurse-led patient education session at baseline and then at three months. The mean duration of the intervention was 65.5+17.9 minutes at baseline and 43.7±18.7 at three months.3 At six months, the acquisition of safety skills was measured using the Biosecure score (0-100 scale), a 55-item validated questionnaire assessing competences to deal with fever, infections, vaccination, and other daily life situations. Patients in the intervention group also had a significantly better capacity to cope with their arthritis.