Following up on the first annual report of the National Early Inflammatory Arthritis Audit (NEIA), published in October 2019, a supplementary report addressing the final metric – annual reviews – has now been produced. Here, BSR’s Head of Policy John Hopgood looks at some key findings in the new report.
The first audit report, published last year, showed some fascinating findings from the first 12 months of data collected – referral times, assessment times and disease monitoring targets among others. One item was missing: at the time the report was produced there was insufficient data to allow reporting on the final metric, annual patient reviews. That’s where the supplementary report comes in.
We now have annual review statuses for more than 1,500 of the patients registered with the audit, which means we’re able to present the first round of data on this metric. The first thing to note is that only 43% of these patients had had an annual review carried out, and that just 15% of those had all three components – cardiac health, bone health and disability assessment.
This is a finding that needs further investigation. Some of the data is still, obviously, incomplete, and the second annual report will likely refine the data to some extent. However, the annual report is a long-standing NICE recommendation, and one strongly supported by patient organisations. We’ll be working with patient organisations and members going forward to better understand where the challenges lie in delivering annual reviews and how they can be addressed.
Alongside the quality standard metric data, the audit collects a number of additional data points on treatment, response and disease impact. One metric used is DAS28 – Disease Activity Score. By this metric, 54% of patients nationally across England and Wales were classified as being in remission. There was some variation across regions, but even the region with the poorest rates – London – saw 49% of patients classified as having a ‘good’ response to treatments.
The report compares these outcomes with access to targeted therapies, and particularly the use of DMARDs (disease-modifying anti-rheumatic drugs). Here, it highlights that patients treated with DMARDs within six weeks of referral have a greater chance of remission at 12 months.
Unfortunately, we also know that relatively few patients progress onto targeted treatments within a year of their first assessment. There are, of course, barriers and restrictions in place on the use of high-cost treatments, but the data is a clear demonstration that we need to ensure they are available to all patients with treatment-resistant disease at the earliest opportunity.
Finally, the report presents a number of patient-reported metrics. These are a fascinating insight into the effectiveness of treatments beyond clinical measures – and a really important reminder that disease and treatment alike have a very real impact on patients’ lives. Happily, we are able to see that treatment does make those improvements – disability reporting shows an improvement at three months and 12 months.
As well as improving physical health, access to proper treatment can dramatically improve mental health as well – the number of patients who screened positive for a mental health co-morbidity was almost halved at 12 months compared to at initial assessment. Lastly, work outcomes also saw improvements over the 12-month reporting period, with a reduction of almost 10 percentage points in the number of patients reporting a work impairment.
Read the report