Background & Objectives
Patients with rheumatoid arthritis (RA) are routinely scheduled for follow-up appointments, but this format may not be sustainable. The ACR workforce study estimates that by 2030 the number of projected rheumatologists in the U.S. will not even meet half the number of needed rheumatologists. The demand for more rheumatology healthcare providers is growing due to the increasing number of patients with RA and the overall increase in healthcare utilization. Additionally, the supply of healthcare providers is dropping due to a shrinking rheumatology workforce.
Therefore, Seppen et al. developed a smartphone application for patients with RA to assess the safety and efficacy of patient-initiated care, compared with usual care. By answering a weekly Routine Assessment of Patient Index Data 3 (RAPID3) questionnaire, patients were able to monitor their own disease activity between clinic visits. Safety was assessed by noninferiority in the Disease Activity Score in 28 Joints and the erythrocyte sedimentation rate (DAS28-ESR). Efficacy was assessed by a reduction in the patient’s number of visits.
Methods
A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the previous six months. Patients were randomized 1:1 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (i.e., the app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28 between the groups.
Results
Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established with a 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups within the noninferiority limit: −0.04 in favor of the app group (95% CI–0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group than in the usual care group (mean ± SD 1.7 ± 1.8 vs. 2.8 ± 1.4; visit ratio 0.62 [95% CI] 0.47, 0.81).
Conclusion
Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28 and led to a 38% reduction in rheumatologist consultations in RA patients with stable, low disease activity. This intervention strategy may reduce the workforce that is needed per RA patient.
For full study details, including source material, refer to the full article.