Session Information
Date: Sunday, November 8, 2015
Title: Health Services Research Poster I: Diagnosis, Management and Treatment Strategies
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: To study the clinical and patient reported outcomes of the Virtual Monitoring Clinic (VMC), which is novel nurse-led telemonitoring cum pharmacy medication home delivery service for monitoring stable Rheumatoid Arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs).
Methods: Patients with stable RA enrolled into the VMC programme were followed up prospectively. The primary outcomes evaluated at 1-year were: Disease Activity Score-28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), and patient satisfaction score assessed using an 11-point Likert scale.
Results: Of the 251 patients enrolled, 186 completed 1year of follow-up. 2.3% of the annual workload from the specialist outpatient clinic was freed up as a result of the VMC programme. Statistically significant improvement was seen in the mean satisfaction score (7.70 to 8.16, p<0.05), with 63% of the patients opting for VMC as their preferred mode of follow-up. There was a marginal increase in mean DAS28 and RAPID3 scores (2.56 to 2.78 (p<0.05) and 5.28 to 6.03 (p<0.05) respectively). However, given that at 1-year more than 60% (72.0% based on DAS28 scores and 63.4% based on RAPID3 scores) of the patients’ condition remained stable or had improved, and the disease was in remission or low activity for the majority of patients (73.1% measured by DAS28 and 53.2% measured by RAPID3), our assessment was that the VMC preserved or improved RA disease activity for the majority of patients.
Conclusion: The VMC is an effective and well-accepted approach for the management of patients with stable RA.
Figure 1. Flowchart illustrating the Virtual Monitoring Clinic (VMC) Workflow
Table 1. Change in the DAS28
|
Follow-up DAS28 |
|||||
|
Baseline DAS28 |
Remission |
Low Activity |
Moderate Activity
|
High Activity |
Total |
|
Remission |
66 (65.3) |
23 (22.8) |
11 (10.9) |
1 (1.0) |
101 (54.3) |
|
Low Activity |
13 (26.5) |
19 (38.8) |
17 (34.7) |
0 (0) |
49 (26.3) |
|
Moderate Activity |
5 (14.3) |
10 (28.6) |
20 (57.1) |
0 (0) |
35 (18.8) |
|
High Activity |
0 (0) |
0 (0) |
1 (100) |
0 (0) |
1 (0.5) |
|
Total |
84 (45.2) |
52 (28.0) |
49 (26.3) |
1 (0.5) |
186 (100)
|
Values are reported as number and percentages.
DAS28, Disease Activity Score 28 joint count.
Table 2. Change in the RAPID3
|
Follow-up RAPID3 |
|
||||
|
Baseline RAPID3 |
Near Remission |
Low Severity |
Moderate Severity
|
High Severity |
Total |
|
Near Remission |
34 (47.2) |
19 (26.4) |
19 (26.4) |
0 (0) |
72 (38.7) |
|
Low Severity |
13 (28.3) |
11 (23.9) |
17 (37.0) |
5 (10.9) |
46 (24.7) |
|
Moderate Severity |
8 (14.3) |
11 (20.4) |
30 (55.6) |
5 (9.3) |
54 (29.0) |
|
High Severity |
1 (7.1) |
2 (14.3) |
8 (57.1) |
3 (21.4) |
14 (7.5) |
|
Total |
56 (30.1) |
43 (23.1) |
74 (39.8) |
13 (7.0) |
186 (100)
|
Values are reported as number and percentages.
RAPID3, Routine Assessment of Patient Index Data 3.
To cite this abstract in AMA style:
Chew LC, Thumboo J, Yang H, Xin X. An Evaluation of the Virtual Monitoring Clinic, a Novel Nurse-Led Telemonitoring Service for Monitoring Patients with Stable Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/an-evaluation-of-the-virtual-monitoring-clinic-a-novel-nurse-led-telemonitoring-service-for-monitoring-patients-with-stable-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/an-evaluation-of-the-virtual-monitoring-clinic-a-novel-nurse-led-telemonitoring-service-for-monitoring-patients-with-stable-rheumatoid-arthritis/