Effectiveness of a novel digital patient education programme to support self-management of early rheumatoid arthritis: a randomised controlled trial.

OBJECTIVES: To evaluate the effectiveness of a novel digital patient education (PE) programme in improving self-management in patients newly diagnosed with rheumatoid arthritis (RA). METHODS: This was a parallel, open-label, two arms, randomised controlled trial with superiority design. Patients from five rheumatology clinics were randomised into digital PE (intervention) or face-to-face PE (control). The primary outcome was self-efficacy, measured by average difference in the Rheumatoid Arthritis Self-Efficacy (RASE) score from baseline to month 12. Secondary outcomes were RA knowledge, health literacy, adherence, and quality of life. Healthcare utilisation data and digital PE programme usage were recorded. Self-efficacy, knowledge, and health literacy data were analysed using mixed-effects repeated measures modelling; adherence using logistic regression, and quality of life and healthcare utilization using descriptive statistics with the Wilcoxon rank-sum test. RESULTS: Of the 180 patients randomised (digital PE, n = 89; face-to-face PE, n = 91), 175 had data available for analysis. Median age was 59.0 years, and 61% were women. The average difference in self-efficacy between groups from baseline to month 12 was significant by a -4.34 difference in RASE score, favouring the intervention group (95%CI -8.17 to -0.51; p= 0.026). RA knowledge, health literacy, and quality of life showed minor improvements over time but no difference between groups, except out-patient clinic contacts which were fewer in the intervention group. CONCLUSIONS: The findings suggest that digital PE is effective in improving self-efficacy and therefore self-management in patients with early RA. This intervention has potential to lower healthcare costs by decreasing out-patient clinic contacts. TRIAL REGISTRATION NUMBER: clinicaltrials.gov, NCT04669340.

Socioeconomic, Disease-Related, and Personal Factors Associated With Participation in Remote Follow-Up in Rheumatoid Arthritis: A Cross-Sectional Study.

OBJECTIVE: To identify socioeconomic, disease-related, and personal factors associated with participation in remote follow-up in patients with rheumatoid arthritis (RA). METHODS: Following the implementation of a patient-reported outcome-based remote follow-up intervention in RA patients in Denmark, a cross-sectional study was conducted among 775 prevalent patients. In 2019, an electronic questionnaire was sent to eligible RA patients, covering health literacy and patient experience regarding involvement and confidence with remote care. Questionnaire data were linked to nationwide registries regarding socioeconomic status, labor market affiliation, and comorbidity level. Associations between registry- and questionnaire-based factors and remote follow-up were analyzed using multiple logistic regression analysis. RESULTS: All 775 patients were included in the registry-based analyses, but only 394 of 646 (61%) completed the questionnaire. No attachment to the labor market or low household income was associated with lower odds of remote follow-up participation (odds ratio [OR] 0.53 [95% confidence interval (95% CI) 0.34-0.83]) and (OR 0.69 [95% CI 0.48-1.00]). Further, a high level of comorbidity was associated with lower odds of remote follow-up participation compared to a low/medium level of comorbidity (OR 0.53 [95% CI 0.34-0.81]). No association was found between health literacy and remote follow-up, but remote follow-up attendees reported more confidence in remote care (OR 1.33 [95% CI 1.21-1.47]). CONCLUSION: Participation in remote follow-up was associated with attachement to the labor market, household income, degree of comorbidity, and confidence with remote care. Additional research is necessary to investigate whether a larger and more divergent group of RA patients should be considered for inclusion in remote follow-up programs.

Experiences With Telehealth Followup in Patients With Rheumatoid Arthritis: A Qualitative Interview Study.

OBJECTIVE: To explore the experiences of a patient-reported outcome (PRO)-based telehealth followup from the perspective of patients with rheumatoid arthritis (RA) and their experiences of increasing their active role, and responsibility for disease control in particular. METHODS: Adopting a strategy of interpretive description, we conducted individual, semistructured interviews with 15 RA patients participating in a telehealth followup. Participants were selected purposively and consecutively from both sexes and with various ages, disease durations, and disease severity. The analysis was inductive, with a constant comparative approach. First, we identified the main themes conveying the participants' experiences. Then we constructed patient typologies to explain different perspectives on the telehealth followup. RESULTS: Five themes covered the participants' experiences: a flexible solution, responsibility, knowledge of RA, communication and involvement, and continuity. Two typologies, the keen patient and the reluctant patient, represented opposite perspectives and preferences regarding the core value of and approach to the telehealth followup. CONCLUSION: The participants had positive perceptions of the PRO-based telehealth followup and saw it as a flexible and resource-saving solution. They reported disadvantages related to missing face-to-face contact with health professionals. The 2 typologies, the keen and the reluctant patient, help us understand the patients' different needs, wishes, and abilities to take part in telehealth followup. Our findings reveal a need for more insight into how telehealth followup could be integrated in routine clinical practice, paying special attention to how reluctant patients may be supported.