Will an App to Monitor Patient Outcomes Improve RA Disease Activity?

Introduction & Objectives

The majority of patients with rheumatoid arthritis (RA) experience at least one flare in a six-month period. Patients with RA describe these increases in disease activity as emotionally distressing and physically disabling. Prompt reporting of flares to healthcare providers should lead to fast resolution of symptoms and control of overall disease activity. In practice, however, many patients fail to notify their healthcare providers of flares occurring between scheduled appointments. Instead, they try to manage the flares on their own.

Smartphone applications (apps) present a unique opportunity to improve the real-time assessment and management of RA by providing ways to collect electronic patient-reported outcomes (ePROs) between physicians’ appointments, present these data to patients and physicians, and identify sustained increases in these ePROs (i.e., flares) that may benefit from early intervention. At least 17 apps aimed at helping RA patients monitor disease activity are publicly available.

Lee et al. examined the effects of using an app to monitor longitudinal ePROs on patient satisfaction and disease activity in patients with RA.

Methods

The researchers conducted a six-month randomized controlled trial of care coordination along with an app (intervention) vs. care coordination alone (control) in 191 RA patients. Participants in the intervention group were prompted to provide information daily using ePROs. In both the intervention and control groups, a care coordinator contacted participants at 6 and 18 weeks to assess for flares. The main outcome measures were the global satisfaction score from the Treatment Satisfaction Questionnaire for Medication (TSQM), the score from the Perceived Efficacy in Patient-Physician Interactions (PEPPI) Questionnaire and the Clinical Disease Activity Index (CDAI) score.

Results

Groups were similar at baseline. The median TSQM score at six months was 83.3 in both groups, and the median PEPPI score at six months was 50 in both groups. The median CDAI score at six months was 8 in the intervention group versus 10 in the control group. No statistically significant group differences in the medians of TSQM, PEPPI, or CDAI scores at six months were detected. Of the 67 intervention participants who completed the exit survey, 90% rated their likelihood of recommending the app as seven or greater on a 10-point scale. Of the 11 physicians who completed the exit survey, 73% agreed or strongly agreed that they wanted to continue offering the app to patients.

Conclusion

A mobile app designed to collect ePRO data on RA symptoms did not significantly improve patient satisfaction or disease activity compared to care coordination alone. However, both patients and physicians reported positive experiences with the app.