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

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 Parts of the validated questionnaire used in the trial (routine assessment of patient index data 3; RAPID3) seemed outdated or not clear enough for many patients.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).

Pre-assessment of patients with suspected axial spondyloarthritis combining student-led clinics and telemedicine: a qualitative study

“…The concept of patient empowerment through telemedicine, of being able to actively help collect data for the rheumatologist at home, was well received. In line with previous results [ 13 ], patients suggested additional app functions such as a “add note”, “help” and “appointment reminder” function for the monitoring app. Patients also expressed dissatisfaction with having to enter the same data at regular intervals and advised a more flexible monitoring approach.…”

Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data

“…Such an educational advancement is pivotal in aligning medical training with the rapidly evolving digital health landscape. By empowering patients and rheumatologists and ensuring their active involvement in TM initiatives, healthcare systems could tackle workforce shortage while achieving high quality and easy to access rheumatology care [ 33 , 34 ].…”

“The Simpler, the Better.” A Qualitative Study on Digital Health Transformation in Early Adopter Rheumatology Outpatient Clinics

“…We chose to conduct 15 interviews as this number has proven to be adequate in previous studies to reach theoretical saturation in the exploration of digital approaches. 8 , 26 The participants were financially compensated for their participation in the study and received a sum of €50 by bank transfer after the interview was completed. Semi structured interviews were conducted by 2 experienced health services researchers (SM, FM) using an open-ended interview guide that was developed to elicit rheumatology nurses’ and physicians’ perspectives on digital transformation in rheumatology outpatient clinics.…”

“… 5 , 6 Particularly in outpatient care, eHealth approaches could contribute to enabling close follow-up while saving human resources. 7 , 8 Digital services, such as telehealth, 9 , 10 mHealth, 11 , 12 specifically digital health applications (DiGA) 13 or app-based ePRO monitoring, 8 and wearables 14 are valuable measures that can support classic therapeutic options. 15 Furthermore, assistive digital systems like voice assistants, 16 systems for obtaining medical anamnesis, 17 and questionnaire-based need-driven appointment management 18 support organizational processes in medical practices, which in turn might be connected in relieving rheumatology workforce 6 ( Figure 1 ).…”

“…19 In 2020, the German Society of Rheumatology (DGRh) launched their position paper of the commission on digital rheumatology of the German Society of Rheumatology. 20 In addition, eHealth received further impetus from Covid-19 and the urge to reduce infections through less face-to-face contact 2 - 23 that also resulted in European recommendations for remote care in rheumatology. 24 Despite advancements, the perspectives of healthcare professionals (HCPs) on digital transformation and its effects within rheumatology outpatient clinics remain largely unexplored.…”