Li-Ching Chew1,2,3, Xiaohui Xin4, Hui Yang4, Julian Thumboo1,2,3. 1. Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore. 2. DukeNUS Medical School, Singapore, Singapore. 3. Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. 4. Medicine Academic Clinical Programme, Singapore General Hospital, Singapore, Singapore.
Abstract
OBJECTIVES: To study clinical and patient reported outcomes for the Virtual Monitoring Clinic (VMC), a remote nurse-led telemonitoring service for monitoring Rheumatoid Arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS: Patients with stable RA enrolled in the VMC were followed up prospectively. The primary outcomes evaluated at 1-year follow-up were: Disease Activity Score-28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), and patient satisfaction assessed using an 11-point Likert scale. RESULTS: Of the 251 patients enrolled, 186 completed 1-year of follow-up. There was a 2.3% (n = 450) reduction in the annual workload from the rheumatology specialist outpatient clinic as a result of the VMC. Statistically significant improvement was seen in the mean patient satisfaction score (7.70-8.16, P ≤ 0.001), with 61.5% of patients opting for the VMC alternating with rheumatology outpatient clinic visits as their preferred mode of follow-up vis-à-vis standard care. There was a marginal increase in mean DAS28 and RAPID3 scores from 2.56 to 2.78 (P < 0.05) and 5.28 to 6.03 (P < 0.05), respectively. However, given that at 1-year follow-up more than half (72.0% and 63.4% based on DAS28 and RAPID3) of the patients' disease activity had improved or remained stable, and was in remission or low activity (73.1% and 53.2% based on DAS28 and RAPID3), the VMC seemed to maintain a stable RA disease activity for the majority of patients. CONCLUSIONS: The VMC is an effective and well-accepted novel approach for the management of patients with stable RA.
OBJECTIVES: To study clinical and patient reported outcomes for the Virtual Monitoring Clinic (VMC), a remote nurse-led telemonitoring service for monitoring Rheumatoid Arthritis (RA) patients treated with disease-modifying antirheumatic drugs (DMARDs). METHODS:Patients with stable RA enrolled in the VMC were followed up prospectively. The primary outcomes evaluated at 1-year follow-up were: Disease Activity Score-28 (DAS28), Routine Assessment of Patient Index Data 3 (RAPID3), and patient satisfaction assessed using an 11-point Likert scale. RESULTS: Of the 251 patients enrolled, 186 completed 1-year of follow-up. There was a 2.3% (n = 450) reduction in the annual workload from the rheumatology specialist outpatient clinic as a result of the VMC. Statistically significant improvement was seen in the mean patient satisfaction score (7.70-8.16, P ≤ 0.001), with 61.5% of patients opting for the VMC alternating with rheumatologyoutpatient clinic visits as their preferred mode of follow-up vis-à-vis standard care. There was a marginal increase in mean DAS28 and RAPID3 scores from 2.56 to 2.78 (P < 0.05) and 5.28 to 6.03 (P < 0.05), respectively. However, given that at 1-year follow-up more than half (72.0% and 63.4% based on DAS28 and RAPID3) of the patients' disease activity had improved or remained stable, and was in remission or low activity (73.1% and 53.2% based on DAS28 and RAPID3), the VMC seemed to maintain a stable RA disease activity for the majority of patients. CONCLUSIONS: The VMC is an effective and well-accepted novel approach for the management of patients with stable RA.
Authors: Isaac D Smith; Theresa M Coles; Catherine Howe; Robert Overton; Nicoleta Economou-Zavlanos; Mary J Solomon; Rong Zhao; Bhargav Adagarla; Jayanth Doss; Ricardo Henao; Megan E B Clowse; David L Leverenz Journal: ACR Open Rheumatol Date: 2022-07-19