BSR Guideline on the Management of Adults with Systemic Lupus Erythematosus (SLE) 2018: Baseline Multi-Centre Audit in the UK

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Colleges, School and Institutes

Abstract

Objectives To assess the baseline care provided to patients with SLE attending UK Rheumatology units, audited against standards derived from the recently published BSR guideline for the management of adults with SLE, the NICE Technology Appraisal for Belimumab, and NHS England’s Clinical Commissioning Policy for Rituxi-mab. 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.

Details

Original languageEnglish
JournalRheumatology (Oxford, England)
Publication statusAccepted/In press - 13 Oct 2020

Keywords

  • Systemic lupus erythematosus, Audit, standards of care, health services research