TELERA—Asynchronous TELEmedicine for Patients With Rheumatoid Arthritis: Study Protocol for a Prospective, Multi-Center, Randomized Controlled Trial

Mücke, Johanna; Knitza, Johannes; Muehlensiepen, Felix; Grahammer, Manuel; Stenzel, Ramona; Simón, David; Kleyer, Arnd; Krönke, Gerhard; Sharp, Charlotte A; Bendzuck, Gerlinde; Korinth, Marianne; Elling-Audersch, Corinna; Vuillerme, Nicolas; Schett, Georg; Pecher, Ann-Christin; Krusche, Martin

doi:10.3389/fmed.2021.791715

Cited by 16 publications

(7 citation statements)

References 30 publications

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“…Therefore, we were eager to explore the potential of a new decentralized digitally-supported patient-centered asynchronous RA care-model, and initiated the multicenter TELERA trial [19] (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Stenzel

Hadaschik

May

et al. 2022

BMC Health Serv Res

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Objective A steadily increasing demand and decreasing number of rheumatologists push current rheumatology care to its limits. Long travel times and poor accessibility of rheumatologists present particular challenges for patients. Need-adapted, digitally supported, patient-centered and flexible models of care could contribute to maintaining high-quality patient care. This qualitative study was embedded in a randomized controlled trial (TELERA) investigating a new model of care consisting of the use of a medical app for ePRO (electronic patient-reported outcomes), a self-administered CRP (C-reactive protein) test, and joint self-examination in rheumatoid arthritis (RA) patients. The qualitative study aimed to explore experiences of RA patients and rheumatology staff regarding (1) current care and (2) the new care model. Methods The study included qualitative interviews with RA patients (n = 15), a focus group with patient representatives (n = 1), rheumatology nurses (n = 2), ambulatory rheumatologists (n = 2) and hospital-based rheumatologists (n = 3). Data was analyzed by qualitative content analysis. Results Participants described current follow-up care as burdensome. Patients in remission have to travel long distances. Despite pre-scheduled visits physicians lack questionnaire results and laboratory results to make informed shared decisions during face-to-face visits. Patients reported that using all study components (medical app for ePRO, self-performed CRP test and joint self-examination) was easy and helped them to better assess their disease condition. Parts of the validated questionnaire used in the trial (routine assessment of patient index data 3; RAPID3) seemed outdated or not clear enough for many patients. Patients wanted to be automatically contacted in case of abnormalities or at least have an app feature to request a call-back or chat. Financial and psychological barriers were identified among rheumatologists preventing them to stop automatically scheduling new appointments for patients in remission. Rheumatology nurses pointed to the potential lack of personal contact, which may limit the holistic care of RA-patients. Conclusion The new care model enables more patient autonomy, allowing patients more control and flexibility at the same time. All components were well accepted and easy to carry out for patients. To ensure success, the model needs to be more responsive and allow seamless integration of education material. Trial registration The study was prospectively registered on 2021/04/09 at the German Registry for Clinical Trials (DRKS00024928).

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Section: Introductionmentioning

confidence: 99%

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Stenzel

Hadaschik

May

et al. 2022

BMC Health Serv Res

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“…It is concluded that the study provides support for the value of implementing Telemedicine in the treatment of rheumatology. 16 …”

Section: Resultsmentioning

confidence: 99%

Telemedicine in Rheumatoid Arthritis: A Review of the PubMed Literature

Barlas,

Basnyat

et al. 2023

MJR

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Objective: The COVID-19 pandemic increased the use of telemedicine in the management of rheumatoid arthritis (RA) patients. The paper intends to provide a narrative review of the PubMed literature (2017–2023) on the application of telemedicine in the management of RA to identify the trends in the application of telemedicine in RA and future research needs. Methods: The PubMed database was used to research data. “Telemedicine” and “rheumatoid arthritis” keywords were entered in the search box. Out of 126 publications between 2017–2023, ones that did not directly address RA, not relate to telemedicine, case reports, preliminary reports and comments to editors were screened. 31 articles were selected for the study. Results: 27 of 31 studies support the value of telemedicine in the monitoring of RA patients. Patient-reported outcomes mostly report positive perceptions, high satisfaction, and convenience. There was no statistically significant difference between telemedicine and hospital visits. Four studies reported the quality of care of telemedicine consultations was inferior to in-person consultations. One of these four studies reported limited health and digital literacy, and older age reduce satisfaction with telemedicine. Comparative and randomised clinical studies and research on modes of telemedicine were limited in quantity. Limitations in study design, lack of evaluation in various settings may impact the generalisability of findings. Conclusion: This review suggests that telemedicine is beneficial in the management of RA, however more studies are needed to pinpoint the most effective uses of telemedicine and to explore alternative health care services for patients with barriers to access telemedicine.

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“…This POC device, QuikRead go [ 20 ], provides exact and fast CRP results, however was not designed for patient use and high costs prevent implementation in routine care. Semiquantitative POC devices, such as those used in the TELERA study [ 21 ], are more affordable, however only indicate ranges of CRP results (i.e., 5–10 mg/l). All of these CRP tests are also based on conventional finger-pricking.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of a hybrid telehealth care pathway for patients with axial spondyloarthritis including self-sampling at home: results of a longitudinal proof-of-concept mixed-methods study (TeleSpactive)

Labinsky,

May,

Boy

et al. 2024

Rheumatol Int

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Patients with axial spondyloarthritis (axSpA) require close monitoring to achieve the goal of sustained disease remission. Telehealth can facilitate continuous care while relieving scarce healthcare resources. In a mixed-methods proof-of-concept study, we investigated a hybrid telehealth care axSpA pathway in patients with stable disease over 6 months. Patients used a medical app to document disease activity (BASDAI and PtGA bi-weekly, flare questionnaire weekly). To enable a remote ASDAS-CRP (TELE-ASDAS-CRP), patients used a capillary self-sampling device at home. Monitoring results were discussed and a decision was reached via shared decision-making whether a pre-planned 3-month on-site appointment (T3) was necessary. Ten patients completed the study, and eight patients also completed additional telephone interviews. Questionnaire adherence was high; BASDAI (82.3%), flares (74.8%) and all patients successfully completed the TELE-ASDAS-CRP for the T3 evaluation. At T3, 9/10 patients were in remission or low disease activity and all patients declined the offer of an optional T3 on-site appointment. Patient acceptance of all study components was high with a net promoter score (NPS) of +50% (mean NPS 8.8 ± 1.5) for self-sampling, +70% (mean NPS 9.0 ± 1.6) for the electronic questionnaires and +90% for the T3 teleconsultation (mean NPS 9.7 ± 0.6). In interviews, patients reported benefits such as a better overview of their condition, ease of use of telehealth tools, greater autonomy, and, most importantly, travel time savings. To our knowledge, this is the first study to investigate a hybrid approach to follow-up axSpA patients including self-sampling. The positive results observed in this scalable proof-of-concept study warrant a larger confirmatory study.

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TELERA—Asynchronous TELEmedicine for Patients With Rheumatoid Arthritis: Study Protocol for a Prospective, Multi-Center, Randomized Controlled Trial

Cited by 16 publications

References 30 publications

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study

Telemedicine in Rheumatoid Arthritis: A Review of the PubMed Literature

Evaluation of a hybrid telehealth care pathway for patients with axial spondyloarthritis including self-sampling at home: results of a longitudinal proof-of-concept mixed-methods study (TeleSpactive)

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