Background The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. Objective This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. Methods Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. Results A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. Conclusions The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.

BACKGROUND The use of patient-reported outcomes (PROs) allows for patient-centered, measurable, and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs, yet limited evidence exists regarding their acceptance, usage, and barriers among rheumatologists. OBJECTIVE This study aims to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the use of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identified. METHODS Data were collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatology of the German Society for Rheumatology (Arbeitsgemeinschaft Junge Rheumatologie der Deutschen Gesellschaft für Rheumatologie [DGRh]) at the 2019 annual DGRh conference. Only members currently working in clinical adult rheumatology were eligible to complete the survey. RESULTS A total of 119 rheumatologists completed the survey, of which 107 (89.9%) reported collecting PROs in routine practice and 28 (25.5%) already used ePROs. Additionally, 44% (43/97) were planning to switch to ePROs in the near future. The most commonly cited reason for not switching was the unawareness of suitable software solutions. Respondents were asked to rate the features of ePROs on a scale of 0 to 100 (0=unimportant, 100=important). The most important features were automatic score calculation and display (mean 77.50) and simple data transfer to medical reports (mean 76.90). When asked about PROs in RA, the respondents listed pain, morning stiffness, and patient global assessment as the most frequently used PROs. CONCLUSIONS The potential of ePROs is widely seen and there is great interest in them. Despite this, only a minority of physicians use ePROs, and the main reason for not implementing them was cited as the unawareness of suitable software solutions. Developers, patients, and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.

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Innovative strategies are needed to adequately assess and monitor disease activity of patients with rheumatoid arthritis (RA) in times of scarce appointments. The aim of the TELERA study is to evaluate the feasibility and performance of asynchronous telemedicine visits based on patient-generated data and patient's drug history. RA patients use a medical app, ABATON, that captures the results of a self-performed quick CRP-test, joint-count, and electronic patient-reported outcomes in between visits. This is a prospective, multi-center, randomized controlled trial performed in four German university centers. The estimated sample size is 120 patients. The main outcome is the agreement of rheumatologists' treatment decisions based on asynchronous telemedicine patient-generated data with traditional in-person rheumatology clinic-based decisions and with patient suggestions. The TELERA trial will provide evidence regarding the implementation of remote care in rheumatology.Clinical Trial Registration: This clinical trial was registered at German Registry for Clinical Trials (DRKS). http://www.drks.de/DRKS00016350, identifier: DRKS00024928.

ZusammenfassungMit der steigenden Verwendung von Smartphones einhergehend, nimmt auch die Nutzung von mobilen Applikationen (Apps) rapide zu. Im medizinischen Kontext könnten chronisch kranke Patienten von dem Einsatz dauerhaft profitieren. Verstärkt wird diese Entwicklung durch das Digitale-Versorgung-Gesetz (DVG), wonach Patienten ab Q4/2020 einen Rechtsanspruch auf bestimmte Apps, sog. digitale Gesundheitsanwendungen (DiGAs), haben, die von den gesetzlichen Krankenkassen erstattet werden. Besonders im Bereich der Rheumatologie bieten sich für das Management chronischer Erkrankungen und ihrer Komorbiditäten verschiedene Anknüpfungspunkte. Nicht nur unter rheumatologischen Patienten ist das Interesse an App-Angeboten groß, sondern auch unter deutschen Rheumatologen zeigt sich eine steigende Bereitschaft, Apps im Berufsalltag anzuwenden und Patienten zu empfehlen. Dieser Artikel will einen Überblick über die Entwicklung der App-Landschaft in der deutschsprachigen Rheumatologie vermitteln.

Background:The use of patient-reported outcomes (PROs) allows for patient-centered, measurable and transparent care. Electronic PROs (ePROs) have many benefits and hold great potential to improve current usage of PROs; yet, limited evidence exists regarding acceptance, usage and barriers among rheumatologists.Objectives:This study aimed to evaluate the current level of acceptance, usage, and barriers among German rheumatologists regarding the utilization of ePROs. The importance of different ePRO features for rheumatologists was investigated. Additionally, the most frequently used PROs for patients with rheumatoid arthritis (RA) were identifiedMethods:Data was collected via an online survey consisting of 18 questions. The survey was completed by members of the Working Group Young Rheumatologists of the German Society for Rheumatology (Deutsche Gesellschaft für Rheumatologie (DGRh)) at the annual 2019 DGRh conference. Only members currently working in clinical rheumatology were eligible to complete the survey.Results:A total of 119 rheumatologists completed the survey. 90% reported collecting PROs in routine practice and 25.5% already used ePROs. 44.3% were planning to switch to ePROs in the near future.The main reason for collecting PROs was for clinical decision making (66.4%), followed by research (39.5%), reimbursement (23.5%), internal quality management (21.9%) and patient satisfaction (16.8%). The most commonly cited reason for not switching to ePROs was the unawareness of suitable software solutions (figure 1).Respondents were asked to rate the features for ePROs on a scale of 0-100 (0 = unimportant, 100 = important). The most important features were automatic score calculation and display (score: 77.5), as well as the simple data transfer to medical reports (76.9) (table 1).When asked about PROs in RA, the respondents listed pain, morning stiffness and physician global assessment (PGA) as the most frequently used PROs (figure 2).Table 1.Ratings for features of ePRO on a scale of 0-100 (0 = unimportant, 100 = important))QuestionmeanSDHow important would the graphic display be to you for ePROs?63.531.19How important would the automatic score calculation and display of ePROs be to you?77.527.64How important would the simple transfer of the ePROs in medical report be to you?76.930.07How important would an automatic alarm of yourself be for you if a critical threshold is exceeded by an ePRO?51.6533.5How important would an automatic alarm of the patient be for you if a critical threshold is exceeded by an ePRO?34.5530.61Figure 1.Reasons why ePROs are currently not used (multiple answers were possible for question)Figure 2.PROs being used in clinical practice and their respective frequencyConclusion:The potential of ePROs is widely seen, and there is a great interest in ePROs. Despite this, a minority of physicians only uses ePROs, and the main reason for not implementing was cited as the unawareness of suitable software solutions.Developers, patients and rheumatologists should work closely together to help realize the full potential of ePROs and ensure a seamless integration into clinical practice.Disclosure of Interests:Martin Krusche Consultant of: Sanofi, Novartis and Medac, Speakers bureau: Roche/Chugai, Novartis, Sobi,, Philipp Klemm Consultant of: Lilly, Medac, Manuel Grahammer Shareholder of: MG is MD and shareholder of Abaton GmbH, Johanna Mucke: None declared, Diana Vossen Consultant of: Medac, Novartis, Abvie, Speakers bureau: Abvie, BMS, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Philipp Sewerin Grant/research support from: AbbVie Deutschland GmbH & Co. KGBristol-Myers Squibb Celgene GmbHLilly Deutschland GmbHNovartis Pharma GmbH Pfizer Deutschland GmbHRheumazentrum Rhein-Ruhr, Consultant of: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Speakers bureau: AMGEN GmbH AbbVie Deutschland GmbH & Co. KG Biogen GmbHBristol-Myers Squibb Celgene GmbH Chugai Pharma arketing Ltd. / Chugai Europe GmbHHexal Pharma Janssen-CilagGmbH Johnson & Johnson Deutschland GmbHLilly Deutschland GmbH / Lilly Europe / Lilly Global Novartis Pharma GmbH Pfizer Deutschland GmbH Roche Pharma Rheumazentrum Rhein-Ruhr Sanofi-Genzyme Deutschland GmbH Swedish Orphan Biovitrum GmbH UCB Pharma GmbH, Johannes Knitza Grant/research support from: Research Grant: Novartis

ZUSAMMENFASSUNGDie Digitalisierung des deutschen Gesundheitswesens schreitet stetig voran. Vielfältige digitale Gesundheitsangebote stehen dabei für verschiedene Indikationen und immer mehr Gruppen an Nutzer*innen zur Verfügung. Vermehrt wird sich daher mit der Adhärenz bei solchen digitalen Technologien auseinandergesetzt, die man als effektive Nutzung einer digitalen Anwendung oder Technologie gemäß den Vorgaben und Anleitungen der Hersteller*innen definieren kann. Diese digitale Adhärenz wird von einer Vielzahl an Faktoren beeinflusst. Betrachtet man insbesondere das Alter der Nutzer*innen, so zeigt sich, dass dieser Faktor weder einen generell-negativen noch generell-positiven signifikanten Einfluss auf die Adhärenz hat. Für eine hohe Adhärenz ist es wichtig, dass Entwickler*innen digitale Technologien nutzerorientiert konzipieren und die individuellen Bedürfnisse einzelner Nutzer*innen berücksichtigen. Aktuelle Forschung in der Rheumatologie beschäftigt sich ebenfalls mit digitalen Gesundheitsangeboten, in denen großes Potenzial für eine bessere und effizientere Versorgung liegt, sowie mit der Adhärenz dieser Angebote. Dabei zeigt sich eine große Bereitschaft zur Nutzung digitaler Technologien, unter anderem auch bei älteren Nutzer*innen. Dieser Artikel gibt einen Überblick über Nutzung und Adhärenz digitaler Gesundheitsangebote unter besonderer Berücksichtigung des Alters der Nutzer*innen und betrachtet die Implikationen für die Rheumatologie als Fachbereich.

We aimed to investigate (1) student-led clinics and (2) electronic patient-reported outcomes (ePROs) to accelerate diagnosis and treatment of patients with axial spondyloarthritis (axSpA). Patients with suspected axSpA completed an initial student-led clinic visit (T-1) prior to their planned actual rheumatologist visit (T0). Acceleration of patient appointment and NSAID therapy start, availability of diagnostic findings, and treatment response at T0 were evaluated. Beginning at T-1, patients completed electronic BASDAI questionnaires every 2 weeks. Concordance of paper-based and electronic BASDAI was evaluated. Patient acceptance of ePRO reporting and student-led clinics was measured using the net promoter score (NPS). 17/36 (47.2%) included patients were diagnosed with axSpA. Student-led clinics (T-1) significantly accelerated patient appointments by more than 2 months (T0, T-1, p < 0.0001) and axSpA guideline-conform NSAID treatment (p < 0.0001). At T0, diagnostic workup was completed for all patients and 7/17 (41.2%) axSpA patients presented with a clinically important improvement or were in remission. 34/36 (94.4%) patients completed at least 80% of the ePROs between T-1 and T0. Electronic and paper-administered BASDAI correlated well (r = 0.8 p < 0.0001). Student-led clinics and ePROs were well accepted by patients with NPS scores of + 62.0% (mean ± SD 9.2/10.0 ± 0.9) and + 30.5% (mean ± SD 8.0/10.0 ± 1.7), respectively. In conclusion, student-led clinics and ePRO monitoring were well accepted, accelerated diagnostic workup and treatment in patients with axSpA.