NEW YORK (Reuters Health—Telemedicine follow up based on patient-reported outcome (PRO) is noninferior to conventional outpatient care for tight control of disease activity in rheumatoid arthritis (RA) patients with low disease activity or remission, new findings show.
“Even though patients in the [telemedicine] follow-up groups requested more acute visits, they over-all had a more than 50% reduction in face-to-face consultations,” Dr. Annette Thurah of Aarhus University Hospital in Denmark and colleagues write. “Hence, the tele-health follow up save(s) patient time and is likely to reduce healthcare costs.”
The European League Against Rheumatism recommends monitoring as often as monthly for RA patients with high/moderate disease activity, and less often, for example every six months, in patients who have sustained low disease activity or who are in remission, Dr. Thurah and her team note.
To investigate whether telemedicine monitoring could offer an alternative to clinic visits for follow-up, the researchers randomly assigned 294 RA patients treated at two outpatient clinics to receive PRO-based telemedicine follow up delivered by a nurse (PRO-TN) or a rheumatologist (PRO-TR), or standard outpatient care.
At Week 52, both PRO-TN and PRO-TR were noninferior based on change in Disease Activity Score 28. The PRO-TN and PRO-TR groups averaged 1.72 and 1.75 outpatient clinic visits, respectively, while the controls averaged 4.15 visits per year.
Over 80% of patients in each of the three groups reported being “very satisfied” with their care, and there were no differences in patient satisfaction among the groups.
Nineteen patients dropped out of the study, most of who were in the PRO-TN group, the authors note.
“We do not know if the fact that patients were contacted by a nurse and not a doctor prompted some to drop out, or if some patients dropped out because they felt generally insecure about attending [telemedicine] control,” they write. “The question is, however, of great importance to future implementation and thus, studies investigating the patients’ perspective on [telemedicine] interventions in RA are needed.”
Dr. Thurah was not available for an interview by press time.
- Thurah A, Stengaard-Pedersen K, Axelsen M, et al. A Tele-health Follow-up Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of the Non-inferiority Randomised Controlled Trail (the TeRA study). Arthritis Care Res (Hoboken). 2017 May 16. doi: 10.1002/acr.23280. [Epub ahead of print]