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Supplemental digital content is available in the text., Background Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care–related factors. Methods Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care–related characteristics that may affect patients' experience. Results A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave “always/mostly” answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care.

Background Non-adherence to medication may lead to poorer clinical outcomes and should be prevented. Objectives We describe the frequency of non-adherence behaviors in patients with rheumatic diseases and its relationship to potentially modifiable variables. Methods Data were obtained through an anonymous survey handed to patients by physicians or nurses from 25 rheumatology clinics from Spain. Patients completed the survey anonymously at home and returned it by pre-paid post mail. Five different non-adherence behaviors were defined. Co-variables analyzed were patients’ demographics, medication characteristics, experience with healthcare (assessed with IEXPAC “Instrument to Evaluate the EXperience of PAtients with Chronic diseases” scoring 0 [worst] to 10 [best experience]), and beliefs in medicines (Beliefs About Medicines Questionnaire [BMQ], composed of a necessity and a concerns subscales and scoring -20 [weaker] to +20 [stronger beliefs]). Variables associated to non-adherence were studied with a multivariate logistic regression model. Results The survey was handed to 625 patients with rheumatic diseases, of which 336 (53.8%) returned it with the necessary data completed (mean age 55 [14] years, 64% women). Of them, 188 (56.0%) described at least one non-adherence behavior. The frequencies of the specific non-adherence behaviors were: 1) Forgetfulness in taking medication: 28.6%; 2) Taking medication at unscheduled hours: 5.6%; 3) Stopping medication when feeling well: 10.1%; 4) Stopping medication when feeling sick: 33.0% and 5) Stopping medication after reading the patients’ information leaflet: 11.5%. The frequency of at least one non-adherence behavior was similar by age, gender, educational level, working status or by number of medicines. It was slightly higher in patients needing to take their medication 3-4 times a day (63.2%) versus 1-2 times a day (52.4%, p= 0.089). IEXPAC scores were similar in patients with or without non-adherence behaviors (5.5 [2.0] in both groups, p= 0.960). BMQ overall score was lower in patients with non-adherence behaviors (4.3 versus 6.5 in those without non-adherence behaviors, p= 0.001). The frequency of non-adherence behaviors did not differ by quartiles of IEXPAC score, but it was higher in patients with lower BMQ score (Q1: 59.5%, Q2: 65.9%, Q3: 54.3%, Q4: 52.0%, p-trend = 0.014). The multivariate model (table) confirmed a relationship of non-adherence behaviors with lower BMQ beliefs scores. Conclusion Non-adherence behaviors are frequent in patients with rheumatic diseases and are mainly associated to patients’ beliefs in their medications (assessed with BMQ). This is an important aspect that can be addressed by clinical teams to improve adherence and clinical outcomes. Acknowledgement: Funded by Merck Sharp & Dohme of Spain and endorsed by 4 patients associations: ACCU, CONARTRITIS, SEISIDA, FEDE. Disclosure of Interests Maria L. Garcia Vivar: None declared, Javier de Toro-Santos: None declared, Lucia Pantoja: None declared, Cristina Lerin Lozano: None declared, Silvia Garcia-Diaz: None declared, Sabela Fernandez Employee of: MSD, Yvonne Mestre Employee of: MSD, Lidia Feo-Lucas Employee of: MSD, Luis Cea-Calvo Employee of: MSD

Background The experience of patients with healthcare has been associated to important outcomes. Objectives We describe the experience with healthcare of patients with rheumatic diseases from Spain self-reported through IEXPAC, a validated questionnaire, and the influence of demographic and health care-related factors. Methods The IEXPAC scale (“Instrument to Evaluate the EXperience of PAtients with Chronic diseases”, http://www.iemac.es/iexpac/) was developed and validated in Spain by health care professional and social organizations, experts in quality of healthcare and chronic patients (1). It consists of 12 items with Likert responses from “always” to “never” and yields an overall score from 0 (worst) to 10 (best experience). Three factors with sub-scores derive from the scale: Factor 1 (productive interactions, average of items 1, 2, 5 and 9, on patient-health care professionals relationship), Factor 2 (new relational model, average of items 3, 7 and 11, on the use of new technologies and contact with other patients) and Factor 3 (self-management, patients’ ability to self-care, average of items 4, 6, 8 and 10). Data were obtained through an anonymous survey to patients from 25 Spanish hospitals. Bivariate comparisons and a multivariate analysis were made to explore the association between scores and demographic and health care-related characteristics. Results 625 patients received the survey, 359 (57.4%) returned it (mean age 55 years, 67% women). The percentage of patients who responded “always” or “nearly always” to the different statements is displayed in table 1. Mean overall IEXPAC score was 5.5 (SD 2.0), sub-scores were: productive interactions: 7.5 (2.5); new relational model: 1.7 (2.1); self-care: 6.5 (2.5). Overall score was higher (better experience) in men (p= 0.022), in those needing follow-up in a different region (p= 0.004), seen by a lower number of physicians (p= 0.025), seen by the same physician each time (p Conclusion Through IEXPAC, patients with rheumatic diseases identified areas of improvement in healthcare, especially those related with access to reliable information and services, interaction with other patients and continuity of health care after hospital discharge. Better experience was associated to being seen by lower number of specialists or being followed-up by the same physician each time, and also with treatment with SC/IV drugs, maybe in relation to the more personalized care these patients receive. Acknowledgement Funded by MSD of Spain and endorsed by 4 patients associations: ACCU, CONARTRITIS, SEISIDA, FEDE. We thank the participant patients for providing this valuable information by completing the survey. Disclosure of Interests Javier de Toro-Santos: None declared, Maria L. Garcia Vivar: None declared, Lucia Pantoja: None declared, Cristina Lerin Lozano: None declared, Silvia Garcia-Diaz: None declared, Yvonne Mestre Employee of: MSD, Sabela Fernandez Employee of: MSD, Luis Cea-Calvo Employee of: MSD

Background: Improving quality of life is a goal in the treatment of patients with rheumatic diseases. Objectives: In this work, we describe the self-assessment of quality of life made by patients with rheumatic diseases and with other chronic diseases through an anonymous survey in the context of a wider project on quality of care. Methods: In the context of a quality of care project, focused in the perceptions of chronic patients with health care in Spain (assessed with the IEXPAC scale (“Instrument to Evaluate the EXperience of PAtients with Chronic diseases”, http://www.iemac.es/iexpac/), a survey was handed patients with 4 different profiles of chronic diseases needing care in at least two different levels (i.e. hospital clinic and primary care): A) Patients with rheumatic diseases (rheumatoid arthritis or spondyloarthritis) from hospital clinics, B) Inflammatory bowel disease (IBD) patients from hospital clinics, C) Patients with human immunodeficiency virus (HIV) infection from HIV units and D) Patients with diabetes mellitus (DM) plus cardiovascular or renal chronic disease from primary care or endocrinology clinics. Patients were handed the survey and completed the survey at home, returning it by pre-paid mail. As part of the survey, they completed the quality of life questionnaire EQ-5D-5L. Results: 2474 patients received the survey, 1618 (65.4%) returned it (359 with rheumatic disease [mean age 55 years, 63% women], 341 with IBD [mean age 47 years, 48% women], 467 with HIV infection [mean age 52 years, 27% women], 451 with DM [mean age 70 years, 32% women). Patients with rheumatic diseases more frequently described moderate or severe problems with mobility, self-care and usual activities and reported more pain (table 1). Patients with rheumatic disease and IBD more frequently reported anxiety or depression (table 1). Scores in the Visual Analogic Scale “Your Health Today” (from 0 worst health to 100 best health) were lower in patients with rheumatic diseases (mean score 61.9 [SD 19.5]) than in patients with IBD (68.8 [17.8]), HIV infection (73.3 [19.1]) or DM (67.0 [17.1]), all multiple comparison tests rheumatic disease versus other, p Conclusions: Self-evaluation by patients showed that quality of life of patients with rheumatic diseases (rheumatoid arthritis, spondyloarthritis) is worse that that of patients with IBD, HIV infection or DM. Improving quality of life is an essential goal to achieve in the care of patients with these rheumatic diseases. Acknowledgements: Funded by Merck Sharp & Dohme of Spain and endorsed by 4 patients associations (CONARTRITIS: patients with arthritis; ACCU: patients with Crohn’s disease and ulcerative colitis; SEISIDA: AIDS multidiscipline group, FEDE: patients with diabetes mellitus). Disclosure of Interest: None declared

Objectives In patients with spondyloarthritis (SpA: axial SpA or psoriatic arthritis [PsA]), treated with golimumab as second biological therapy (after failure or withdrawal of a first anti TNF-α drug), we describe patients’ insights with regard to their beliefs and their satisfaction with golimumab therapy. Methods Patients on golimumab from GO-BEYOND, a retrospective study undergone in 20 Spanish rheumatology clinics, were requested to respond to the Beliefs About Medicines Questionnaire (BMQ). Statements of the BMQ include a 5-item necessity and a 5-item concern scale with Likert response options from “strongly agree” to “strongly disagree”. Patients also responded to questions on their satisfaction and experience with golimumab self-injection. Descriptive data are displayed, and responses to the BMQ in axial SpA vs PsA patients were compared with the chi-square test. Results 123 patients on golimumab as second anti TNF-α responded (81 axial SpA and 42 PsA, mean age 49 years [SD=11], 40% women). Patients showed strong beliefs in the necessity of golimumab for the treatment of their SpA (percentages of “agree” or “strongly agree” to the necessity statements: 50%–80%), but also concerns: half the patients agreed/strongly agreed to be worried about long term effects of golimumab, and ≈30% about becoming too dependent on the drug (table 1). Responses were similar in axial SpA and PsA patients (table 1). 111 patients declared to self-inject golimumab. Of these, 22.7% considered the experience with self-injection as very positive, 66.4% as positive, 10.0% neutral and only 0.9% unfavourable, and the use of the device very easy (37.3%), easy (57.3%), neutral (3.6%) and only 1.8% difficult. Finally 36.4% and 49.1% were very satisfied or satisfied with the interval of administration of golimumab, 11.8% were neutral and only 1.8% and 0.9% declared to be dissatisfied or very dissatisfied. Conclusions Patients with SpA currently using golimumab as second anti TNF-alpha describe strong beliefs in the necessity of golimumab and good experience and satisfaction with self-administration. The BMQ also identified concerns that should be addressed in the clinic. The study is limited to the subset of patients still on golimumab at the study visit. Acknowledgements Funded by Merck Sharp and Dohme, Spain Disclosure of Interest None declared

Background In patients with rheumatoid arthritis (RA), we previously described that adherence to the subcutaneous (SC) biological treatment is better with monthly administration. Objectives We further assessed if there are differences in patients expectations and satisfaction with efficacy and tolerance that could contribute to explain such finding. Methods ARCO was a retrospective study on RA patients who had been prescribed a SC biological 11–18 months prior to the study. Adherence was calculated with the medication possession ratio (MPR). Satisfaction and expectations were assessed with the Spanish validated Carbonell questionnaire [1]. Results We included 364 patients (age 54.9 years [SD 12.5], 77.5% women, median duration of RA 7.8 years, period studied for the SC biological 14.8 months). Non-adherence (MPR ≤80%) was lower in patients with monthly (6.4%) than with weekly (17.4%, p=0.034) or every 2 weeks administration (14.4%, p=0.102). The % of satisfied patients (quite/very satisfied) was 86.2% for efficacy and 64.4% for side effects or tolerance. Non-adherence was similar in satisfied with efficacy and in neutral/unsatisfied patients (14.7% vs. 8.3%, p=0.399), or in patients satisfied/not satisfied with side effects (13.1% vs. 15.4%, p=0.504). The fulfillment of expectations is shown in the table. With regard to expectations on the effect, non-adherence was 15.5% (higher than expected), 12.6% (as expected) and 10.7% (lower than expected) (p=0.677), and with regard to discomfort/side effects, it was 15.6% (greater than expected), 18.5% (as expected) and 11.1% (lower than expected, or no side effect) (p=0.189). Fulfilment of expectation on efficacy was similar for the 3 dosing schemes, but the % reporting lower than expected discomfort or no discomfort was greater with fewer SC injections (table). In particular, the % reporting no discomfort/side effects with the administration were 17.8% (weekly), 29.3% (every 2 weeks), and 35.0% (monthly) (p=0.013). Conclusions RA patients on SC biological therapy show high satisfaction and fulfillment of expectations on efficacy, although both aspects lower for tolerance. Dosing regimen with lower number of SC injections seems to be associated with better fulfillment of expectations of tolerance. This finding, added to the lower number of injections itself, might explain the better adherence observed with monthly administration. References Carbonell J, Badia X; Grupo Expresar. Development and validation of a satisfaction questionnaire in patients with rheumatoid arthritis. Reumatol Clin 2006;2:137–45. Acknowledgements Funded by MSD, Spain. Disclosure of Interest None declared

Background Lack of adherence to medication in rheumatoid arthritis (RA) can worsen disease activity. Objectives To evaluate the risk of non-adherence to disease modifying antirheumatic drugs (DMARD) in RA patients treated with subcutaneous (SC) biological therapy. Methods ARCO was a retrospective study in RA patients ≥18 years-old from 42 Spanish hospitals on SC biological therapy. The risk of non-adherence to oral DMARD was evaluated using the Compliance Questionnaire in Rheumatology (CQR), a questionnaire validated against an electronic medication-monitoring system, for a cut-off point of taking ≤80% of the doses. Patients completed the Beliefs About Medicines Questionnaire (BMQ) and the Carbonell satisfaction questionnaire (Spanish validated questionnaire on satisfaction with medication). Results 364 patients were included (mean age 54.9 years [SD 12.5]; 77.5% women median RA duration 7.8 years). Complete CQR was available for 304 patients, of which 21.7% showed risk of non-adherence to oral DMARD (95% CI: 17.4 – 26.7%). The percentage was similar in men and women, and greater in extremes of age (>63 and ≤48 years-old), in those currently working and in patients with no comorbidities (Table). There was a trend to a higher percentage at risk of non-adherence in non-Caucasian patients, those with higher educational level and in those with risk of alcoholism (AUDIT questionnaire) (Table). The percentage with risk of non-adherence was similar in patients with 1, 2 or >2 oral drugs for RA, and in those treated or not with SC methotrexate, and it was higher in those who considered that the effect of their treatment for RA on the symptoms had been less than expected (38.1% vs 17.9% in those who thought it had been greater, p=0.029). No differences were seen with regard to the result of the BMQ. Conclusions In patients with RA treated with SC biological therapy, 21.7% showed risk of non-adherence to DMARD according to the CQR (taking ≤80% of the doses). The percentage was higher in extremes of age, patients with university degree, employed, without comorbidities and in those who considered that the treatment effect on RA had been lower than expected. Acknowledgement The ARCO study was funded by Merck Sharp & Dohme Spain. Disclosure of Interest None declared