Methods: SLE cases attending outpatient clinics during any 4-week period between February–June 2018 were retro-spectively audited to assess care at the preceding visit. The effect of clinical environment (general vs. dedi-cated CTD/vasculitis clinic and specialised vs. non-specialised centre) were tested. Bonferroni’s correction was applied to the significance level.
Results: 51 units participated. We audited 1021 episodes of care in 1003 patients (median age 48 years, 74% diag-nosed >5 years ago). Despite this disease duration, 286 (28.5%) patients had active disease. Overall 497 (49%) were receiving prednisolone, including 28.5% of patients who had inactive disease. Low documented compliance (<60% clinic visits) was identified for audit standards relating to formal disease-activity assess-ment, reduction of drug-related toxicity and protection against comorbidities and damage. Compared to general clinics, dedicated clinics had higher compliance with standards for appropriate urine protein quantifi-cation (85.1% vs 78.1%, p =< 0.001). Specialised centres had higher compliance with BILAG-BR recruit-ment (89.4% vs 44.4%, p =< 0.001) and blood pressure recording (95.3% vs 84.1%).
Conclusions: This audit highlights significant unmet need for better disease control, reduction in corticosteroid toxicity and is an opportunity to improve compliance with national guidelines. Higher performance with nephritis screen-ing in dedicated clinics supports wider adoption of this service-delivery model.
- Systemic lupus erythematosus
- standards of care
- health services research