Telemedicine in the management of rheumatoid arthritis: maintaining disease control with less health-care utilization

Abstract

Objectives We aimed to evaluate the use of an eHealth platform and a self-management outpatient clinic in patients with rheumatoid arthritis (RA) in a real-world setting. The effect on healthcare utilization and disease activity were studied. Methods Using hospital data of patients with RA between 2014 and 2019, the use of an eHealth platform and participation in a self-management outpatient clinic were studied. An interrupted time series analysis compared the period before and after the introduction of the eHealth platform. The change in trend (relative to the pre-interruption trend) for the number of outpatient clinic visits and the disease activity score 28-joints (DAS28) was determined for several scenarios. Results After the platform’s implementation in April 2017, the percentage of patients using it was stable around 37%. On average, the users of the platform were younger, more highly educated and had better health outcomes than the total RA population. After the implementation of the platform, the mean number of quarterly outpatient clinic visits per patient decreased by 0.027 per quarter (CI = [-0.045;-0.08], p-value = 0.007). This was accompanied by a significant decrease in DAS28 of 0.056 per quarter (CI = [-0.086;-0025], p-value = 0.001). On average this resulted in 0.955 less visits per patient per year and a 0.503 reduction in the DAS28 Conclusions The implementation of remote patient monitoring has a positive effect on healthcare utilization, while maintaining low disease activity. This should encourage the use of this type telemedicine in the management of RA, especially, when many routine outpatient clinic visits are cancelled due to COVID-19.

The ideal mHealth-application for rheumatoid arthritis: qualitative findings from stakeholder focus groups

“…Since the T2T-strategy implies a need for frequent assessment of treatment response, such a remote monitoring approach holds promise to predict the need for urgent clinic visits in patients with high disease activity, but also to reduce the number of clinical visits for well-controlled patients [ 12 ]. By consequence, remote monitoring of symptoms through mHealth-applications could present a possible cost-saving measure [ 13 ], even though the potential impact on quality of care warrants further investigation.…”

Comment on: Telemedicine in the management of rheumatoid arthritis: maintaining disease control with less health-care utilization

“…Based on past experience, we do not want to repeat the problems that arose with Electronic Health Records, in which the clerical burden, the lack of interoperability between disparate systems and the non-intuitive interfaces led to significant physician dissatisfaction and a higher risk of professional burnout [ 13 ] while failing to facilitate the integrated care that our patients require. In this work, Müskens et al [ 1 ] demonstrate that the efficient implementation of digital tools is possible. It shall be a source of inspiration to continue generating evidence on such a necessary and important field.…”

“…As they concluded, real-world implementation of remote monitoring can reduce the number of hospital visits, while maintaining disease control. Their publication provides interesting evidence for assessing new evidence-based digital tools in health care [ 1 ].…”

“…For instance, it has been shown that health-care professionals may underestimate pain in RA, leading to potential divergences between patients and doctors [ 4 ]. An added value of the digital solution used in this study is that it includes patient-reported outcomes measures (PROMs) [ 1 ]. Evidence about correlation between PROMs and disease activity scores in RA is increasing [ 5 ].…”

“…The manuscript by Müskens et al [ 1 ] highlights that the time to understand what happens to the patient outside of the medical appointment is now. The coronavirus disease 2019 pandemic has pushed society towards a dramatic, and often chaotic, adoption of digital health tools.…”