63. Characterising AAV and GCA vasculitis services across UK and Ireland – priorities for collaborative care

Background/ Objectives: The Vasculitis Outcomes In relation to Care Experience Study (VOICES), aims to understand the key patterns of service configuration underpinning effective care. In collaboration with the UK and Ireland Vasculitis Society (UKIVAS) and the Scottish Systemic Vasculitis Network (SSVN), an online questionnaire explored a range of service features including size, service model, human resources, facilities, organisation and processes of care.

Methods: Vasculitis services across nephrology and rheumatology in 87 UKIVAS sites, plus 11 Scottish regional health boards, were approached to complete the survey between Nov 2020 and June 2021.

Results: We received 59 responses from 51 Trusts/Health Boards across Scotland (n=11), England (n=33), Wales (n=2), and Ireland (n=5). This included an equal split of respondents from nephrology and rheumatology working across a range of healthcare settings; teaching hospitals, tertiary referral centres, and district general hospitals.  2/3rds said their service was recognised by NHS England as a specialised centre. 86% had a local care pathway for GCA and 63% had a local care pathway for AAV. 73% were able to see vasculitis patients for follow up at least weekly; 19% daily; and 23% indicating less frequent follow up (monthly or less). Vasculitis patient were seen in a range of different clinics; dedicated/subspecialty plus other clinics that included general and/or flare clinics. 41% held joint vasculitis clinics with other specialties, most commonly rheumatology, nephrology, ENT and respiratory, and a smaller number with dermatology and ophthalmology. 30% held parallel clinics with a broader spread of specialties, predominately rheumatology, nephrology, ENT and respiratory. In patient management of vasculitis was mainly under the care of individual specialties, with a smaller proportion reporting the presence of a dedicated in-patient vasculitis team or review team. 80% have the opportunity to discuss vasculitis patients at an MDT; most commonly local speciality meetings, followed by local primary vasculitis and regional vasculitis MDTs. As an outcome of MDTs, almost 50% reported proposing changes in patient management; 30% recommending prescription of biologics; 25% requesting additional investigation; 25% recording MDT outcomes to their health board/trust. All respondents had the ability to provide biologic and cytotoxic infusions, the majority of which was available within their own specialty day unit or use of another day unit facility (average wait time for urgent cases 2.7 days (range 1-10 days)). 52% have Specialist Nurses working directly within their vasculitis service. Activities included; infusion delivery, nurse-led clinics and patient advice line. 94% have staff trained to administer cytotoxic therapy, and 70% would find a regional or training module helpful. 88% enter data to a national registry, mostly commonly by research nurses senior clinicians and research assistants. 48% have a local database, most commonly completed by senior clinicians.

Conclusions: Priorities for services include support for; specialist nurse led care, delivery of timely biologics/cytotoxic infusions, and support for MDT meetings. Other priorities in light of the COVID-19 pandemic include support for remote care delivery and hybrid care pathways. From the survey we have identified key pillars of service underpinning effective care for patients with systemic vasculitis to support regional service planning and improve outcomes.

Disclosure: None