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Impact stories

Smartphone self-monitoring leads to a 38% reduction in rheumatologist consultations

Patients with rheumatoid arthritis (RA) are routinely scheduled for follow-up appointments, but this format may not be sustainable. The American College of Rheumatology (ACR) workforce study estimates that by 2030 the number of projected rheumatologists will not even meet half the number of needed rheumatologists.

The demand for more rheumatology health care providers is growing due to the increasing number of patients with RA and the overall increase in health care utilisation. Additionally, the supply of health care is dropping due to a decreasing rheumatology workforce. Therefore, we will need to provide more health care with the same capacity of people and resources.

Currently, in the Netherlands, most patients with RA consult their physician every 3 to 6 months, following the EULAR guidelines.

As a solution, outpatient clinics could revert from preplanned visits to providing “health care on demand,” in which patients are expected to initiate health care themselves when needed. The effectiveness of patient-initiated care in patients with RA is still under investigation. Hewlett et al, Primdahl et al, and Poggenborg et al have shown that patients who self-initiate care (for 2 to 6 years) were clinically and psychologically at least as well and had fewer appointments than patients with physician-initiated regular appointments.

The smartphone application

The app notified patients each week to complete their RAPID3 in the app. The results of the RAPID3 could be used by patients to monitor themselves during the year, to reflect on the course of their disease, and to contact the outpatient clinic in a timely manner in case of progressive complaints. Additionally, communication with the physician/nurse at the outpatient clinic was easier, as they also had access to their data. In the app, a RAPID3 algorithm was used to identify potential RA flares. An increase in the RAPID3 score by >2 points (from the previous data point) combined with a RAPID3 score of >4 led to a flare notification. The notification informed the patient about the possible flare, linked to self-management tips, and presented the advice to contact a rheumatology nurse if deemed necessary by the patient. Scores in the app were not used to trigger contact from clinician to patient. The data collected in the app was synchronized in real-time with the EMR at Reade.

In addition, managers are much more involved in drawing up the budget because they have insight into the most important data – in real-time.

Patient-initiated care supported by smartphone self-monitoring was non-inferior to usual care and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.

So far, self-monitoring of RA disease activity with ePROs has not been shown to improve patient satisfaction or disease activity. Still, improvements have been seen in terms of self-management skills, patient empowerment, patient-physician interaction, and physical activity.

Several studies also demonstrate high acceptance rates of self-monitoring and high questionnaire completion during studies. In addition, self-monitoring can lead to a reduction in outpatient clinic visits by ~50%. To date, none of these studies have combined patient-initiated care (to reduce the number of visits) with self-monitoring (to maintain disease control).

Read the full study here.

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