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Abstract Number: 148

An Evaluation of the Virtual Monitoring Clinic, a Novel Nurse-Led Telemonitoring Service for Monitoring Patients with Stable Rheumatoid Arthritis

Li-Ching Chew1, Julian Thumboo1, Hui Yang2 and Xiaohui Xin3, 1Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore, 2Division of Medicine, Singapore General Hospital, Singapore, Singapore, 3Academic Clinical Programme, Division of Medicine, Singapore General Hospital, Singapore, Singapore

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Chronic disease care, Disease Activity, Patient Satisfaction, patient-reported outcome measures and rheumatoid arthritis (RA)

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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.


Disclosure: L. C. Chew, None; J. Thumboo, None; H. Yang, None; X. Xin, None.

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 .
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