Article Text

SP0248 Search and You Will Find: How Eular Recommendations are Developed and Implemented on A National Level
  1. Y. van Eijk-Hustings
  1. Patient & Care/Rheumatology, Maastricht University Medical Centre, Maastricht, Netherlands


Background The roles of rheumatology nurses vary widely across countries and within countries. European League Against Rheumatism (EULAR) recommendations for their role might contribute to a more standardised level of professional rheumatology nursing across Europe. Methods for developing EULAR recommendations are described in the EULAR standardardised operating procedures for EULAR-endorsed recommendations (SOPs) [1]. A strategy for dissemination of the recommendations should be included in a proposal for developing the recommendations. Implementation of the recommendations in daily clinical practice is the final goal but dissemination is the crucial first step. Usually, successful implementation requires a change in practical habits and behaviour and therefore, additional interventions are necessary.

Methods Based on available evidence from a systematic literature search, a multidisciplinary taskforce, representing different health professionals and patients from different regions in Europe, formulated the recommendations in a consensus meeting. In addition, a research agenda and an educational agenda were identified. Through a web-based survey the recommendations were disseminated among nurses, rheumatologists and patients throughout Europe and the USA. The level of agreement with these recommendations and the level of application in daily practice were sought and potential barriers for implementation of the recommendations were identified.

Results 10 evidence-based and expert opinion-based recommendations for the role of the nurse in the management of chronic inflammatory arthritis were developed [2]. In total, 3594 persons (967 nurses, 2034 patients, and 548 rheumatologists) from 22 countries in Europe and the USA gave their opinion about these recommendations. In general, median level of agreement was high (8-10) with rheumatologists' responses displaying the largest variation. Median level of application was much lower (0-8) and the variation was much larger in each group and for each recommendation. Differences across countries and regions appeared. According to the participants in the survey, potential barriers were “too many other responsibilities” (nurses), “doubts about knowledge of the nurse” (rheumatologists) and “fear to lose contact with the rheumatologist” (patients). Additional barriers for application were “lack of time” (nurses) and “insufficient number of nurses” (rheumatologists). Many patients stated that the service was not being offered [3].

Conclusions The EULAR recommendations for the role of the nurse in the management of CIA can enable a homogenisation of rheumatology nursing care across Europe. Agreement with these recommendations is high, but the level of application is lower indicating that further implementation strategies are required. Country specific information can be used to target strategies to specific national barriers.


  1. van der Heijde D, et al. Ann Rheum Dis 2015;74:8-13. doi:10.1136/annrheumdis-2014-206350

  2. van Eijk-Hustings Y, et al. Ann Rheum Dis 2012;71(1):13-19. doi:10.1136/annrheumdis-2011-200185

  3. van Eijk-Hustings Y, et al. Rheumatology (Oxford) 2014;53:1491-96. doi:10.1093/rheumatology/keu134

Disclosure of Interest None declared

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