AB1265 Loss of specialty medical care for elderly rheumatoid arthritis patients who discharged from hospital

Background As the ageing of the population progresses, the proportion of the population over the age of 65 reaches 27.3% in 2016, in Japan. Even elderly rheumatoid arthritis (RA) patients often require immunosuppressive agents or biological disease modifying antirheumatic drugs (DMARDs) due to their high disease activity. Therefore, they need to continuously receive treatment by specialty rheumatologists. Due to the deterioration of the ability of daily living activities, some patients may drop out of specialty medical care. In recent years, the age of RA patients who need to be hospitalised has also increased. However, it is unclear whether elderly patients discharged from the hospital are able to continue receiving specialty medical care. Objectives To clarify whether a patient who has been discharged from a rheumatology specialty hospital can continue receiving rheumatology specialty medical care. Methods RA patients who discharged from our rheumatology unit from January 1, 2016 to December 31, 2016, were included. We investigated the backgrounds and outcomes of those patients retrospectively. We compared the background characteristics of patients who are receiving treatment by specialty rheumatologists at the final follow-up (specialty group) and those who are not (non-specialty group). For the statistical analysis, a chi-squared test and Student’s t-test were used. Results We identified 147 patients. The mean ±SD age of patients at discharge was 72.2±9.1 years and 74.8% was female. The reasons for hospitalisation were 87 patients (59.2%) for treatment of RA and 60 (40.8%) for treatment of complications (sepsis, fracture and so on). After discharge, 134 patients (91.1%) had returned to follow up in our department for RA treatment. The remaining 13 patients were treated at other hospitals, five of whom were treated by a primary care physician who was not specialised for rheumatology. Overall, we compared 142 patients in the specialty group and 5 in the non-specialty group. The age, the use ratio of immunosuppressive agents/biological DMARDs/prednisolone and the dose of prednisolone in the specialty group and the non-specialty group were 71.9 and 79.0 years old (p=0.09), 50.0% and 20.0% (p=0.37), 29.6% and 20.0% (p=1.00), 78.7% and 80.0% (p=1.00), 6.5 and 5.6 mg/day (p=0.83), respectively. Conclusions In elderly RA patients, some patients drop out of RA specialty medical care. The background of such patients is not different from those of patients who are receiving treatment by specialty rheumatologists. In order to provide specialty medical care for RA patients throughout the community, a co-management medical collaboration system between specialty rheumatologists and primary care doctors should be established. Disclosure of Interest None declared