Spondyloarthritis

Quality standards for axSpA aim to improve management, unmet needs


Rapid access to care, treatment, and self-management are three of nine new quality standards developed by a multidisciplinary task force of the Assessment of SpondyloArthritis international Society (ASAS) with the ultimate aim of improving the management of adults with axial spondyloarthritis.

Work to develop the ASAS-QS began in 2016, prompted by the wide variation in the delivery and quality of healthcare for patients with axial spondyloarthritis (axSpA) across the world.

The international task force, comprising 20 rheumatologists, two physiotherapists and two patients with axSpA, identified key gaps in the current provision of care at the community level, noting several unmet needs such as delayed diagnosis and restricted access to treatment in many countries worldwide.

They say the ASAS-QS may serve as a tool for assessing, delivering and demanding optimal care for patients with axSpA in any country.

“QS are intended to help organisations improve quality of care and to monitor service improvements by supporting comparison of current performance. All ASAS-QS are achievable in daily care in an optimised situation and intend to minimise variation in quality of care.”

“Even though it may currently not be realistic to achieve the QS in all healthcare systems, they provide high-quality of care framework for patients with axSpA that should be aimed for,” they noted.

“The ASAS-QS should now be implemented at a national level for local quality improvement.”

In the UK, the new quality standards will sit alongside the quality assessment tool for patients with axSpA recently published by NICE.

The task force notes that the NICE tool was developed in parallel to the ASAS-QS set and none of the ASAS members participated in NICE guidance and the groups didn’t exchange ideas.

“Interestingly, areas addressed are quite similar and topics covered in both sets are the domains of referral and assessment as well as the importance of exercise and education about the disease,” they said.

They stress that the ASAS-QS have been designed to complement rather than replace other methods to improve quality of care, and that focusing on key areas increases the chances of inducing substantial improvement in quality of care.

Nine quality standards

The first three QS deal with clinical symptoms and diagnosis, looking at time to referral from primary care to rheumatologist and assessment times. They state patients with suspicion of asSpA are referred within three working days, assessed by a rheumatologist within three weeks of referral, and have their diagnostic work-up completed within two months.

QS four, five and six cover both pharmacological management and non-pharmacological treatment. QS4 states that disease activity of patients is monitored under the supervision of a rheumatologist with validated composite scores at least every 6 months. QS5 looks at disease control, stating in patients with axSpA and active disease despite conventional therapy, treatment escalation with biological drugs is discussed. The sixth QS deals with the need to inform patients about the benefits of regular exercise.

The final three QS look at management: QS7 states patients are offered education on the disease including self-management within two months of diagnosis; dealing with rapid access, QS8 states patients with axSpA and disease flare or possibly drug-related side effects receive advice within two working days of contacting the rheumatologist; and QS9 states patients have a comprehensive annual review by the rheumatologist.

Full details of the ASAS-QS are published in Ann Rheum Dis here. 

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