Background/Purpose: China doesn’t have efficient primary medical care and referral system. Patients can choose any hospitals or any doctors they like to seek medical care. As a result, most patients with rheumatic diseases rushed to a few large cities. Surveys showed that more than 40% of the rheumatic disease patients were unnecessary to go to hospital and they only need advices from specialist. Smart System of Disease Management (SSDM) is a series of applications for chronic diseases management, which strengthens the interaction between doctors and patients based on valuable clinical data. Our previous study showed that rheumatoid arthritis (RA) patients can master the SSDM and perform self-management after training, including disease activity score with 28 joints (DAS28) and health assessment questionnaire (HAQ) evaluations, as well as medication and lab test data entries. The purpose of this study is to evaluate the feasibility and benefit of the medical economics of online consultation based on SSDM by rheumatologist.

Methods: The rheumatologists implemented the education and training programs on patients in using SSDM and assist the patients in downloading SSDM mobile application. The SSDM includes doctors’ and patients’ interfaces. The patient’s terminal system includes self-assessment (DAS28, HAQ), medication management, adverse events management and laboratory records. After data entry, patients can synchronize data to the authorized doctor. On the basis of these data, the rheumatologists can accept the request from their follow-up patients and practice consultation through SSDM in the form of text or voice.

Results: From February 2015 to June 2017, 403 rheumatologists supplied 4,002 patients (RA 42%, systemic lupus erythematosus 21%, ankylosing spondylitis 11%, gout 10%, osteoarthritis 5%, Sjogren syndrome 3% and other rheumatic diseases 7%) with 293 free and 3,709 paid consultations. Paid consulting included 3,983 times text Q&A and 19 voice consultations. The consulting fee ranged from RMB 10 to 500 yuan (UDS: RMB =1: 6.81) each in average of 96.06 ± 38.61 yuan, which match the registration fee in hospital. The total collection of fee for consultations was 477,960 yuan RMB. 35.3% patients receiving online consultation lived in different city with the rheumatologists. If patients seek medical care in hospital, in addition to the registration fees and medical expenses, the mean cost of transportation, accommodation, meals and lost wages was 565.17 ± 510.49 (200 – 2,800) yuan. The total of cost for all patients would have been 3,157,220 yuan RMB, which is 6.61 times higher compared with the cost of online. Online consultations through the SSDM can save 84.86% of the cost for patients. Survey shows that all patients were satisfied and 66.35% of them were “very satisfied” with the consultations.

Conclusion: Through online consultations using SSDM system, Chinese patients with rheumatic diseases can enjoy reduced cost with high satisfaction. In the era lack of primary care system in China, SSDM may serve as a complimentary platform to control medical care cost, as well as develop a new partnership between physicians and patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/online-consultation-for-chinese-patients-with-rheumatic-diseases-based-on-smart-system-of-disease-management-ssdm-mobile-tool-a-study-of-medical-economics/