Date: Sunday, November 7, 2021
Session Type: Poster Session B
Session Time: 8:30AM-10:30AM
Background/Purpose: The demand on outpatient rheumatology clinics is high due to protocolised visits of rheumatoid arthritis (RA) patients, including those in low disease activity or remission. We developed a mobile phone app for patients with RA, which allows them to self-monitor their disease activity in between clinic visits by answering a weekly routine assessment of patient index data (RAPID-3). The objective of this study is to assess efficacy and safety of self-initiated care assisted by a smartphone app in patients with RA.
Methods: A randomised controlled trial was performed with a study duration of one year. Inclusion criteria were: 1) diagnosed with RA by a rheumatologist, 2) disease duration of at least two years and 3) a Disease Activity Score 28 (DAS28) below 3.2 at the start of the study. Patients were excluded if they had initiated or discontinued conventional DMARDs or a biological in the previous 6 months. Patients were randomised to either app supported self-initiated care with only one scheduled follow-up consultation after a year (app-group) or to usual care. The app warned patients that they could be flaring when RAPID-3 scores increased more than 2 points and the overall score was over 4. The co-primary outcome was mean number of consultations with a rheumatologist and non-inferiority in terms of difference in DAS28 at 12 months. The non-inferiority limit was set at 0.5 difference in DAS28 between the groups. Secondary outcomes included consultations with nurses, satisfaction with healthcare and app usage.
Results: In total, 103 patients were randomised to usual care (n=53) or to the app group (n=50). Baseline characteristics were similar in both groups (table 1). At 12 months, the mean number (±SD) of outpatient or telephone consultations with the rheumatologist was significantly lower in the app group compared with usual care (1.7±1.8 vs 3.0±1.4, p< 0.001). The same applied to the nurse outpatient or telephone consultations (0.4±1.0 vs 0.9±1.1, p=0.03; table 2). Non-inferiority was established as the 95% confidence interval of the mean difference in DAS28 between the groups was within the non-inferiority limit: -0.04 in favour of the intervention group ([95% CI], -0,39, 0.30). Satisfaction with healthcare received was high (8.6 out of 10 ±1.3) in both groups and not statistically different. On average patients completed 56% (29/52, SD13.3) of the weekly questionnaires.
Conclusion: The results of this study show that self-initiated care supported with weekly RAPID3 self-monitoring via a smartphone app reduces the number of outpatient visits and telephone consultations and is non-inferior to usual care in terms of the DAS28. We propose the implementation of this approach to optimise rheumatologic care for RA patients in low disease activity.
To cite this abstract in AMA style:Seppen B, Wiegel J, ter wee M, van Schaardenburg D, Roorda L, Nurmohamed M, Bos w. Smartphone Assisted Patient Initiated Care Safely Reduces Outpatient Clinic Visits in Patients with Rheumatoid Arthritis: Results from a Randomized Controlled Trial [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/smartphone-assisted-patient-initiated-care-safely-reduces-outpatient-clinic-visits-in-patients-with-rheumatoid-arthritis-results-from-a-randomized-controlled-trial/. Accessed September 25, 2022.
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