Background/Purpose: Patient-initiated services in rheumatology have been found to be cost-saving without compromising the clinical or psychosocial well-being of patients with rheumatoid arthritis. Self-monitoring is a technique used in many other long-term conditions and is associated with reductions in healthcare utilisation and mortality and has been found to be satisfactory from the patient’s perspective. The aim of this study was to evaluate the efficacy of a service which integrates self-monitoring into patient-initiated follow-ups for patients with RA or PsA on methotrexate; in terms of healthcare utilisation and clinical outcomes; using a mixed methods approach including a randomised controlled trial (RCT) and qualitative semi-structured interviews.

Methods: One hundred patients with RA or PsA (according to ACR/EULAR/CASPAR criteria)on methotrexate were randomised to either an intervention group or usual care. All participants were assessed over 6 blood tests. Those in the intervention group attended one training session where they were taught how to monitor their blood test results and which symptoms and side effects they should report. These participants had no scheduled appointments with their rheumatology nurse during the trial period, but continued with their consultant appointments as usual. Blood test results were sent to intervention participants and along with their assessment of symptoms and side effects; patients initiated a review with their nurse, when necessary. If these reviews were required an immediate outpatient appointment was made. Healthcare utilisation was monitored throughout the trial period. Poisson regressions and multi-level modelling were used to explore the impact of the intervention on healthcare usage and clinical outcomes.

Results: There were no significant differences in clinical or demographic variables between the two groups at baseline. Across the trial period 77% of decisions made by intervention participants were considered to be safe. At the end of the trial period participants in the intervention group had 54.55% fewer appointments with their rheumatology nurse specialist (p<0.0001). There were no significant differences in the number of appointments with the rheumatologist or GP. Levels of pain, fatigue, ESR, CRP and disease activity did not differ between groups (p>0.05). Intervention participants were positive about the new model of care, valuing its efficiency and tailored approach. The service allowed patients to gain new knowledge and use this information along with the skills they obtained to take control of their health and arthritis.

Conclusion: After brief training patients with RA and PsA can successfully understand and interpret their blood test results and use this information along with reports of their symptoms and side effects to initiate appropriate reviews with their rheumatology nurse. Participants in the intervention group had fewer hospital appointments with their nurse specialist with no detrimental effects to their clinical status and with no increase in visits to the rheumatologist or GP. This model of care offers a viable alternative for established RA and PsA patients on DMARD therapy.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-development-and-evaluation-of-a-self-monitoring-and-patient-initiated-follow-up-service-for-people-with-rheumatoid-or-psoriatic-arthritis-on-methotrexate/