Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one year randomized trial
Résumé
Objective. To evaluate the impact of a nurse-led program of systematic screening for the management (detection/prevention) of comorbidities. Methods. Prospective, randomized, controlled, open, 12-month trial (NCT02374749). Participants: consecutive patients with axial Spondyloarthritis (axSpA) (according to the rheumatologist) The program. A nurse collected data on comorbidities during a specific outpatient visit. In the event of non-agreement with recommendations, the patient was informed and a specific recommendation was given to the patient (orally and in a with a detailed written report). Patients were seen after one year in a nurse-led visit. Treatment allocation. random allocation (i.e. either this program or an educational program not presented here and considered here as the control group). Main outcome. : change after one year of a weighted comorbidity management score (0 to 100 where 0= optimal management). Results. 502 patients were included (252 and 250 in the active and control groups, respectively): age: 47±12 years, male gender: 63%, disease duration: 14±11y. After one year, no differences were observed in a weighted comorbidity management score. However, the number of patients in agreement with recommendations was significantly higher in the active group for vaccinations (flu vaccination: 28.6% vs. 9.9%, p<0.01; pneumococcal vaccination:40.0% vs. 21.1%,p=0.04), for cancer screening (skin cancer screening: 36.3% vs. 17.2%, p=0.04) and for osteoporosis (bone densitometry performed: 22.6% vs. 8.7%, p<0.01; Vitamin D supplementation initiation: 51.9% vs. 9.4%, p<0.01). Conclusions and relevance. This study suggests the short-term benefit of a single-visit nurse-led program for systematic screening of comorbidities for its management in agreement with recommendations, even in this young population of patients with axSpA.
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