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Labinsky H, May S, Boy K, von Rohr S, Grahammer M, Kuhn S, Rojas-Restrepo J, Vogt E, Heinze M, Schett G, Muehlensiepen F, Knitza J. 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). Rheumatol Int 2024; 44:1133-1142. [PMID: 38602534 PMCID: PMC11108867 DOI: 10.1007/s00296-024-05581-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
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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Affiliation(s)
- Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany.
| | - Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Sophie von Rohr
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Manuel Grahammer
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Abaton GmbH, Berlin, Germany
| | - Sebastian Kuhn
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
| | | | | | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School, Immanuel Hospital Rüdersdorf, Rüdersdorf, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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Almansouri AY, Alsofyani R, Alharbi HA, Almaqati AS, Aloqbi HS, Bakhsh L, Althubaiti A, Alzahrani Z. Comparison of Remotely Applied and Face-to-Face Disease Activity Scores in Saudi Arabian Patients With Rheumatoid Arthritis: A Prospective Cohort Study. Cureus 2024; 16:e52390. [PMID: 38361704 PMCID: PMC10868911 DOI: 10.7759/cureus.52390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2024] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES This study aimed to assess the disease activity indices (DAI) of rheumatoid arthritis (RA) by telephone-based tele-visits compared to face-to-face clinic encounters. METHODS Patients with RA attending outpatient clinics between December 2021 and May 2022 were prospectively recruited. Disease activity assessments were initially performed in the clinic using the disease activity score 28-C-reactive protein (DAS28-CRP) and disease activity score 28-erythrocyte sedimentation rate (DAS28-ESR). Within two weeks of the clinic visit, a telephone-based assessment gathered information on demographics, Routine Assessment of Patient Index Data 3 (RAPID3) score, and satisfaction. Disease activity scores were dichotomized into remission or low disease activity and moderate to high disease activity. RESULTS A total of 78 patients completed the two-point interview. Of those, 62 (79.49%) were women, with a mean age of 54.73±13.71 years. Seropositivity for rheumatoid factor and/or anti-citrullinated peptide was observed in 51 (83.61%) participants. Twenty-seven percent of the patients were classified as in remission or low disease activity by RAPID3. This was 71% for DAS28-CRP and 33% for DAS28-ESR. Based on the dichotomized disease activity classification, the agreement percentage between RAPID3 and DAS28-ESR was 78.08%, while it was 47.22% between RAPID3 and DAS28-CRP, which resulted in kappa statistic values of 0.48 (moderate agreement) and 0.14 (low agreement), respectively. Satisfaction rates were low. CONCLUSION Telephone-based RAPID3 showed a low-moderate agreeability compared to DAS28 and had low satisfaction rates. This suggests that tele-rheumatology care by this means was not feasible for following up with patients with RA and warrants further development.
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Affiliation(s)
- Abdulrahman Y Almansouri
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
- Department of Medicine, King Faisal Specialist Hospital and Research Center, Madinah, SAU
| | - Rahaf Alsofyani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hanin A Alharbi
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
| | - Ahmed S Almaqati
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hind S Aloqbi
- Department of Medicine/Rheumatology, King Abdulaziz Medical City, Jeddah, SAU
- Department of Medicine, King Fahad Hospital, Tabuk, SAU
| | - Lama Bakhsh
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
| | - Alaa Althubaiti
- College of Medicine, King Saud Bin Abdulaziz University for Health and Sciences, Jeddah, SAU
| | - Zeyad Alzahrani
- Department of Medicine, King Abdulaziz Medical City, Jeddah, SAU
- Internal Medicine, King Abdullah International Medical Research Center, Jeddah, SAU
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Phatak S, Chakraborty S, Goel P. Computer vision detects inflammatory arthritis in standardized smartphone photographs in an Indian patient cohort. Front Med (Lausanne) 2023; 10:1280462. [PMID: 38020147 PMCID: PMC10666644 DOI: 10.3389/fmed.2023.1280462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Computer vision extracts meaning from pixelated images and holds promise in automating various clinical tasks. Convolutional neural networks (CNNs), a deep learning network used therein, have shown promise in analyzing X-ray images and joint photographs. We studied the performance of a CNN on standardized smartphone photographs in detecting inflammation in three hand joints and compared it to a rheumatologist's diagnosis. Methods We enrolled 100 consecutive patients with inflammatory arthritis with an onset period of less than 2 years, excluding those with deformities. Each patient was examined by a rheumatologist, and the presence of synovitis in each joint was recorded. Hand photographs were taken in a standardized manner, anonymized, and cropped to include joints of interest. A ResNet-101 backbone modified for two class outputs (inflamed or not) was used for training. We also tested a hue-augmented dataset. We reported accuracy, sensitivity, and specificity for three joints: wrist, index finger proximal interphalangeal (IFPIP), and middle finger proximal interphalangeal (MFPIP), taking the rheumatologist's opinion as the gold standard. Results The cohort consisted of 100 individuals, of which 22 of them were men, with a mean age of 49.7 (SD 12.9) years. The majority of the cohort (n = 68, 68%) had rheumatoid arthritis. The wrist (125/200, 62.5%), MFPIP (94/200, 47%), and IFPIP (83/200, 41.5%) were the three most commonly inflamed joints. The CNN achieved the highest accuracy, sensitivity, and specificity in detecting synovitis in the MFPIP (83, 77, and 88%, respectively), followed by the IFPIP (74, 74, and 75%, respectively) and the wrist (62, 90, and 21%, respectively). Discussion We have demonstrated that computer vision was able to detect inflammation in three joints of the hand with reasonable accuracy on standardized photographs despite a small dataset. Feature engineering was not required, and the CNN worked despite a diversity in clinical diagnosis. Larger datasets are likely to improve accuracy and help explain the basis of classification. These data suggest a potential use of computer vision in screening and follow-up of inflammatory arthritis.
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Affiliation(s)
| | | | - Pranay Goel
- Indian Institute of Science, Education and Research, Pune, India
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Chan A, Knitza J. Remote monitoring in rheumatology: seeing the right patient at the right time. Nat Rev Rheumatol 2023; 19:680-681. [PMID: 37550496 DOI: 10.1038/s41584-023-01008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Affiliation(s)
- Antoni Chan
- Department of Rheumatology, Royal Berkshire NHS Foundation Trust, Reading, UK
| | - Johannes Knitza
- Department of Internal Medicine 3- Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany.
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Misra DP, Ravindran V. Rheumatology research in the post-COVID era-challenges and solutions. Rheumatology (Oxford) 2023; 62:489-491. [PMID: 35792824 DOI: 10.1093/rheumatology/keac390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/16/2022] [Accepted: 07/02/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow
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Muehlensiepen F, May S, Zarbl J, Vogt E, Boy K, Heinze M, Boeltz S, Labinsky H, Bendzuck G, Korinth M, Elling-Audersch C, Vuillerme N, Schett G, Krönke G, Knitza J. At-home blood self-sampling in rheumatology: a qualitative study with patients and health care professionals. BMC Health Serv Res 2022; 22:1470. [PMID: 36461025 PMCID: PMC9718468 DOI: 10.1186/s12913-022-08787-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/04/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The goal of the study was to investigate patients' with systemic rheumatic diseases and healthcare professionals' experiences and preferences regarding self-sampling of capillary blood in rheumatology care. METHODS Patients performed a supervised and consecutive unsupervised capillary blood self-collection using an upper arm based device. Subsequently, patients (n = 15) and their attending health care professionals (n = 5) participated in an explorative, qualitative study using problem-centered, telephone interviews. Interview data were analyzed using structured qualitative content analysis. RESULTS Interviewed patients reported easy application and high usability. Patients and health care professionals alike reported time and cost savings, increased independence and flexibility, improved monitoring and reduction of risk of infection during Covid-19 as benefits. Reported drawbacks include limited blood volume, limited usability in case of functional restrictions, and environmental concerns. Older, immobile patients with long journeys to traditional blood collection sites and young patients with little time to spare for traditional blood collection appointments could be user groups, likely to benefit from self-sampling services. CONCLUSIONS At-home blood self-sampling could effectively complement current rheumatology telehealth care. Appropriateness and value of this service needs to be carefully discussed with patients on an individual basis. TRIAL REGISTRATION WHO International Clinical Trials Registry: DRKS00024925. Registered on 15/04/2021.
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Affiliation(s)
- Felix Muehlensiepen
- grid.473452.3Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, Rüdersdorf Bei Berlin, 15562 Rüdersdorf, Germany ,grid.473452.3Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany ,grid.450307.50000 0001 0944 2786AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Susann May
- grid.473452.3Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, Rüdersdorf Bei Berlin, 15562 Rüdersdorf, Germany
| | - Joshua Zarbl
- grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Ekaterina Vogt
- grid.424957.90000 0004 0624 9165Thermo Fisher Scientific, Freiburg, Germany
| | - Katharina Boy
- grid.473452.3Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, Rüdersdorf Bei Berlin, 15562 Rüdersdorf, Germany
| | - Martin Heinze
- grid.473452.3Brandenburg Medical School Theodor Fontane, Center for Health Services Research, Seebad 82/83, Rüdersdorf Bei Berlin, 15562 Rüdersdorf, Germany ,grid.473452.3Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, Rüdersdorf, Germany
| | - Sebastian Boeltz
- grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerlinde Bendzuck
- grid.491693.00000 0000 8835 4911Deutsche Rheuma-Liga Bundesverband E.V, Bonn, Germany
| | - Marianne Korinth
- grid.491693.00000 0000 8835 4911Deutsche Rheuma-Liga Bundesverband E.V, Bonn, Germany
| | | | - Nicolas Vuillerme
- grid.450307.50000 0001 0944 2786AGEIS, Université Grenoble Alpes, Grenoble, France ,grid.440891.00000 0001 1931 4817Institut Universitaire de France, Paris, France ,grid.4444.00000 0001 2112 9282LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
| | - Georg Schett
- grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Gerhard Krönke
- grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- grid.450307.50000 0001 0944 2786AGEIS, Université Grenoble Alpes, Grenoble, France ,grid.5330.50000 0001 2107 3311Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany ,grid.5330.50000 0001 2107 3311Deutsches Zentrum Für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
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Guaracha-Basáñez GA, Contreras-Yáñez I, Estrada-González VA, Estrada-González VA, Valverde-Hernández SS, Hernández-Molina G, Pascual-Ramos V. Comparison of Teleconsultations and In-Person Consultations from Outpatients with Rheumatoid Arthritis, During the COVID-19 Pandemic: An Internal Audit of Medical Notes. Telemed J E Health 2022; 28:1835-1842. [PMID: 35506921 DOI: 10.1089/tmj.2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The objectives of this study were to compare the quality-of-care and compliance with medical record regulations between in-person consultations (QIP and CIP) and telephone consultations (QTP and CTP), from rheumatoid arthritis (RA) outpatients, during the COVID-19 pandemic, and to explore the impact of the consultation modality on the treatment. Methods: Data from 324 medical notes corresponding to rheumatic consultations between July and December 2020 were abstracted. Notes were selected considering a stratified (in-person and telephone consultations) random sampling strategy. QIP, CIP, QTP, and CTP were scored based on prespecified criteria as percentages, where higher numbers translated into better standards. Logistic regression analysis investigated the association between the consultation modality and the treatment recommendation (dependent variable). Results: There were 208 (64.2%) medical notes related to in-person consultations and 114 (35.2%) to telephone consultations. Overall, medical notes corresponded to middle-aged women with long-standing disease. QIP was superior to QTP (median, interquartile range): 60% (60-75%) versus 50% (25-60%), p ≤ 0.001, and differences were related to disease activity and prognosis documentation (81.3% vs. 34.5% and 55.8% vs. 33.6%, respectively, p ≤ 0.001) and the prolonged prescription of glucocorticoids with a documented management plan (58.5% vs. 30.4%, p = 0.045). Meanwhile, CIP and CTP were similar. Telephone consultation was a significant risk factor for no changes in the treatment recommendation (odds ratio: 2.113, 95% confidence interval: 1.284-3.479, p = 0.003), and results were consistent in the 142 medical notes with documented absence of disease activity. Conclusions: In the clinical context of RA, the quality-of-care provided by telephone consultations is below the standard of care and impacts the treatment.
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Affiliation(s)
- Guillermo A Guaracha-Basáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Salvador S Valverde-Hernández
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
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Stenzel R, Hadaschik K, May S, Grahammer M, Labinsky H, Welcker M, Hornig J, Bendzuck G, Elling-Audersch C, Erstling U, Korbanka PS, Vuillerme N, Heinze M, Krönke G, Schett G, Pecher AC, Krusche M, Mucke J, Knitza J, Muehlensiepen F. Digitally-supported patient-centered asynchronous outpatient follow-up in rheumatoid arthritis - an explorative qualitative study. BMC Health Serv Res 2022; 22:1297. [DOI: 10.1186/s12913-022-08619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
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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Guaracha-Basáñez GA, Contreras-Yáñez I, Estrada González VA, Pacheco-Santiago LD, Valverde-Hernández SS, Pascual-Ramos V. Impact of a hybrid medical care model in the rheumatoid arthritis patient-reported outcomes: A non-inferiority crossover randomized study. J Telemed Telecare 2022:1357633X221122098. [PMID: 36046945 DOI: 10.1177/1357633x221122098] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Patients and physicians can naturally adopt hybrid healthcare models that combine face-to-face consultations with telemedicine. The study's objective was to compare the impact of two healthcare interventions, hybrid care modality and face-to-face consultation, on the patient-reported outcomes of rheumatoid arthritis patients, during the COVID-19 pandemic. METHODS Consecutive outpatients reincorporated to a clinic previously in lockdown were invited to a non-inferiority, randomized study (October 2020--May 2022). Patients were randomized to 6 months of face-to-face consultation or hybrid care modality (intervention period-1) and then the converse modality (intervention period-2). The primary outcome was disease activity/severity behavior (Routine Assessment of Patient Index Data 3). Additional patient-reported outcomes were disability (Health Assessment Questionnaire Disability Index), quality-of-life (World Health Organization quality of life questionnaire-brief version), adherence and satisfaction with medical care, and treatment recommendation. Sample size calculation established 55 patients/healthcare interventions. RESULTS There were 138 patients invited to participate, 130 agreed and 121 completed their study participation. Sixty-one and 60 patients respectively, received face-to-face consultation and hybrid care modality over intervention period-1. Patients were primarily middle-aged females (90.1%), with (median, IQR) 12 (9-16) years of education, long-standing disease, working (62.8%), receiving disease-modifying anti-rheumatic drugs (96.7%), and corticosteroids (61.2%). Patients had low disease activity (median Routine Assessment of Patient Index Data 3: 2.7) and Health Assessment Questionnaire Disability Index score that translated into the absence of disability, while quality of life was compromised. Baseline characteristics were similar between patients assigned to each healthcare intervention. Differences in Routine Assessment of Patient Index Data 3 behavior were below the non-inferiority margin. Results considered the order in which patients received the intervention and baselines scores, and extended to the patient-reported outcomes left. CONCLUSIONS Hybrid care modality was non-inferior to in-person consultations in achieving patient-reported outcomes during the COVID-19 pandemic in rheumatoid arthritis patients.
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Affiliation(s)
- Guillermo A Guaracha-Basáñez
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
- Emergency Medicine Department, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ), Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
| | - Vivian A Estrada González
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
| | - Lexli D Pacheco-Santiago
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
| | - Salvador S Valverde-Hernández
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, 42559Instituto Nacional de Ciencias Médicas y Nutrición Salvador-Zubirán (INCMyN-SZ, Mexico City, Mexico
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