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ObjectivesTo examine the association between the perception of COVID-19 risk, confidence in health services and avoidance of emergency department (ED) visits in Portugal during the COVID-19 pandemic.DesignCommunity-based, cross-sectional survey.SettingVolunteer sample that completed the online survey between April 2020 and May 2021.Participants987 participants who perceived needing ED care. Of those, 242 reported avoiding ED visits.Outcome measuresLogistic regression models for ED avoidance were conducted to estimate the effect of risk perception and confidence in health services, adjusted for sociodemographics, health status and time.ResultsThe adjusted odds for ED avoidance were higher for participants lacking confidence in health service response to non-COVID-19 conditions (adjusted OR: 6.39; 95% CI 3.19 to 12.82) and COVID-19 (1.81; 1.19 to 2.77) and lower for those perceiving a low risk of being infected at a health provider (0.16; 0.07 to 0.38).ConclusionIn our sample, confidence in health services and risk perception of infection at a health provider were associated with the decision to avoid the ED. These results suggest that policymakers and care providers need to mitigate the negative consequences of delayed healthcare; be aware of the implications of distrust and fear from those in need of healthcare and provide equally distributed safe alternatives to ED care.

Background Registries are becoming an increasingly important source of data, providing additional information on the use of biologics in clinical practice. The real-world clinical data currently available regarding the use of SC anti-TNFs is still limited. Therefore, it is of utmost importance to increase the knowledge of Golimumab (GLM) effectiveness in the clinical practice. Objectives This study was designed to access the effectiveness of SC GLM 50 mg/monthly + MTX through 52 weeks of treatment in biologic-naive RA patients. The primary objective was to investigate the proportion of patients achieving clinical remission (DAS28ESR 0.22); and the effect of treatment on DAS28 individual components. Methods This was a retrospective non-interventional study based on the Rheumatic Diseases Portuguese Register (Reuma.pt). It was conducted in a cohort of patients aged >18 years with active RA despite previous treatment with conventional DMARDs, biologic-naive, who started SC GLM+MTX, from March 2011 to August 2015. The cumulative incidence of achieving clinical remission, treatment persistence and functional response/remission were estimated using survival analysis. Cox regression was used to calculate the hazard ratios. Results A total of 109 patients (86.3% female, mean age 55.5±13.2 years; mean age of diagnosis 45.5±13.5 years, rheumatoid factor 78% positive) met the study criteria. Ninety-three had a follow up of at least 52 weeks (i.e. all patients who started treatment before August 2014). At week 52, 38.3% of patients were on clinical remission, 91.9% achieved functional response and 35.2% were on functional remission (HAQ Conclusions This is the first Golimumab data analysis generated from the Portuguese registry Reuma.pt. Our results are in agreement with data from other national registries and demonstrate the long-term effectiveness and the high treatment persistence rates of GLM through 52 weeks. Disclosure of Interest A. F. Mourao Consultant for: Merck Sharp & Dohme, C. Ribeiro: None declared, J. Borges: None declared, M. J. Goncalves: None declared, M. Bernardes: None declared, S. Fernandes: None declared, R. Dezerto Employee of: Merck Sharp & Dohme, P. A. Laires Employee of: Merck Sharp & Dohme, P. Machado Employee of: Merck Sharp & Dohme, M. Eusebio: None declared, M. J. Santos: None declared, H. Canhao: None declared

Background The quality of medical care and the implementation of measures to improve it are crucial steps for the development of Rheumatology in Europe. Quality indicators were obtained through a four-step rand-modified Delphi methodology. A final set of 26 quality indicators was defined within Donabedian framework dimensions: 9 “structure”, 11 “processes” and 6 “outcomes” indicators. Herein we describe the second implementation phase of a national program, Rheuma Space (RS), aiming at quality improvement in Rheumatology. Objectives To develop a quality improvement plan for care provided by Rheumatology Departments (RD). In this second phase we present the results of the RD evaluation. Methods A measurement scale on quality/excellence thresholds was developed for each of the 26 criteria. Eight RD participated in the project and each one set up an Investigation Team of 2–3 members for field criteria measurement and evaluation that required the use of different data sources and focused on the period: 2014 – 1st semester of 2015. After data analysis an individual report was delivered and discussed with each of the 8 RD. Afterwards public presentation and discussion of the results took place. Results “Structure” was evaluated in terms of personal, training, facilities, equipment and budgeting: RD lack Rheumatology specialists and need fully dedicated nurses Training plans exist in all RD, but physicians allocate few time to research Equipment is appropriate, nonetheless microscopes and computers could be updated Internal contracting is well established and professionals are committed to targets “Processes” were evaluated in terms of access and medical care, clinical records, physician-patient communication and multidisciplinary patient management: Triage criteria for first appointments should be standardized, despite compliance for “High Priority” patients Follow up could be more frequent, but direct access in emergencies is guaranteed Reuma.pt registry is mainly used for patients under biologics and data completion could improve Multidisciplinary care is provided, but patient coverage and specialty diversity can increase. “Outcomes” were evaluated in terms of clinical outcomes, patient and personal satisfaction: Average working absence is Almost 1/3 of patients requested early retirement at a median age >50years Patients are satisfied with provided care and physicians9 attitude, but less with RD facilities Professionals are satisfied with working environment, however criticize career related aspects. Conclusions The 26 quality indicators set the basis of this quality management tool that was applied to 8 Portuguese RD. Strengths and weakness were identified and an individual Department report was elaborated and discussed. Interventions are now being planned based on these results in order to ensure quality standards of structure and process criteria for a patient oriented clinical practice, favouring desirable continuous quality improvement on health outcomes. Acknowledgements Investigation Teams from the eight Rheumatology Departments that participated in the Rheuma Space Project. Disclosure of Interest None declared

Background Osteoarthritis (OA) is a very common and disabling rheumatic condition with its onset often while people are still in paid employment. OA may generate difficulties in performing work tasks, leading to early exit from work. Objectives We aim to examine the association between OA and early exit from work by using large real-world observational data. Methods EpiReumaPt (Portuguese Epidemiological Study of Rheumatic Diseases) was a national, cross-sectional, population-based study conducted from September 2011 to December 2013. EpiReumaPt involved a three-stage approach: Phase 1 - face-to-face interview randomly performed at participants9 households; Phase 2 - all subjects that screened positive for at least one musculoskeletal condition in Phase 1, and also 20% of individuals with no musculoskeletal complaints were referred to a rheumatologist observation; Phase 3 – all diagnosis and clinical data were reviewed considering previously validated classification criteria. Thus, EpiReumaPt randomly surveyed 10,661 inhabitants in order to capture and characterize all cases of rheumatic diseases within a representative sample of the Portuguese population, which were stratified by administrative territorial units (NUTSII). In this analysis we used all participants aged near the official retirement age (i.e. 50 to 65 years old). The association of clinically confirmed OA and early exit from paid work (including early retirement, unemployment, unpaid homemakers and disability pensions) was tested using individual level logistic regression, Multivariable models were adjusted for age, gender, region (NUTSII), education level (primary school or less, medium and high), household income and other chronic diseases. All estimates were computed as weighted proportions, in order to take into account the sampling design. Results The estimated prevalence of OA in the Portuguese population with ages between 50 and 64 years old is 29.7% (knee: 18.6%; hand: 12.6%; hip: 3.6%). Among these, 61.8% were out of paid work versus 47.6% for those without OA ( p =0.004). A non-statistically difference was observed when analyzing specifically official early retirement (32.6% vs. 29.1%, respectively; p =0,437). Thus, OA is associated with early exit from work (unadjusted OR: 1.78; CI: 1.19-2.65; p =0.005. Adjusted OR: 1.83; CI: 1.12-2.96; p =0.015), but not with official early retirement (OR: 1.18; CI: 0.78-1.79; p =0.437). Of particular note, knee OA seems to be strongly associated with early exit from work (unadjusted OR: 2.21; CI: 1.49-3.29; p p =0.008), while none significant association was observed for hand OA (OR: 1.20; CI: 0.78-1.86; p =0.405) and hip OA (OR: 0.99; CI: 0.33-2.98; p =0.998). Conclusions In this nationwide epidemiological study, we measured the high prevalence of OA in critical ages for early retirement. Moreover, we found a significant association between OA and early exit from work, but not with early official retirement. This likely mean that while society somehow avoid official retirement due to OA, other routes of early withdrawal from paid work are taking place. Identification of these alternative routes and setting up interventions to reduce or discourage them is crucial for the future sustainability of social protection policies. Disclosure of Interest None declared

Background Chronic diseases and in particular rheumatic diseases (RD) may lead to early retirement, generating substantial costs to society. Objectives We aim to examine the association between self-reported RD and early retirement by using large real-world observational data. Methods EpiReumaPt was a national, cross-sectional, population-based study conducted from September 2011 to December 2013. 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population, which were stratified by administrative territorial units (NUTSII). In this analysis we used all participants aged between 50 and 65 years old, near the official retirement age (N=2,792; females: 1,727). The association of self-reported RD and early retirement was tested using individual level logistic regression. All estimates were computed as weighted proportions, in order to take into account the sampling. Results 29.9% of the Portuguese population with ages between 50 and 64 years old were officially retired. Among these, 43.2% were retired due to ill-health, which in turn about a third (30.4%) was specifically due to RD. Thus, 13.1% of all retirees self-reported RD as the main reason for early retirement. More than a third (34.2%; females: 46.3%) of all study population self-reported RD, being also more likely to self-report other main chronic disease (OR: 3.4; CI: 2.53-4.65; p p =0.025). Prevalence of self-reported RD seems to be associated with early retirement (unadjusted OR: 1.45; CI: 1.05-2.01; p =0.025). Some other characteristics are also associated with early retirement, in particular older age, male gender and presence of other chronic diseases. RD association tends to be independently associated with early retirement (adjusted OR: 1.41; CI: 1.03-1.95; p =0.031). Conclusions These results are in line with previous data from the National Health Survey conducted in Portugal nearly a decade ago and confirms the impact that self-reported RD still have on early retirement. Nevertheless, further analysis should be done in order to analyze clinically confirmed RD and to address the different RD and its relationship with early retirement. Disclosure of Interest None declared