Background Targeted treatment and close monitoring improve outcome of early RA, and frequent visits may increase patient confidence and drug adherence. Lack of resources may be an obstacle. To solve this problem we have developed an automated remote monitoring system SandRA (Showing-any-need-for-Re-Assessment) based on short message service (SMS) of cell phones and patients’ global assessment of the severity of RA (PtGA) on a numeric scale of 0 to 10.
Objectives To examine the validity and feasibility of the SandRA monitoring.
Methods In SandRA, patients with RA starting their first DMARD are registered in the software, and baseline PtGA is recorded. During the following 6 months, SandRA sends every 2 to 6 weeks an automatic SMS to a patient’s cell phone, and the patient answers by one push on keyboard. The first 2 SMSs concern medications (“Have you used the prescribed drugs?” Y/N) and adverse events (“Have you experienced any problems with the drug?” Y/N). From 6 weeks onwards, PtGA is inquired: (“What is the severity of RA on scale 0 to 10, when 0 corresponds absence of RA symptoms and 10 as severe RA symptoms as you can imagine?”).
Based on our data from previous early RA cohorts, a treatment target was set at 5-3/10 to reach at 6 months a target of ≤2/10, which according to our data equals to remission or low disease activity. The patients’ answers are recorded in SandRA and automatically analysed. If patient’s answers show no problems and responses to treatment are within the set target, the patient receives SMS: “Thank you for your answer. Have a nice day”. If answers indicate non-adherence, adverse events, or missed target, the system automatically sends SMS: “Your nurse will call you within 2 work days”, and the nurse gets an alarm by e-mail. If needed, an extra visit is arranged for treatment adjustments. The patients’ regular doctor appointments are scheduled at 3 and 6 months.
The patients in SandRA were analysed regarding the achievement of target at 6 months. PtGA given by cell phone was validated. Structured feedback was gathered from patients and professionals.
Results 137 consecutive patients were registered in SandRA. After 6, 10, 18, and 22 weeks, SandRA identified due to active disease or drug problems 34%, 31%, 29%, and 31% of the patients, respectively. Roughly two third of patients achieved the target of ≤2/10 at 6 months. PtGA showed sufficient convergent validity when compared with DAS28 and physician’s GA. Of 56 patients, 98% expressed sense of secureness brought by SandRA. 95% felt the system easy or rather easy to learn and use, and 66% did not find it difficult to assess the activity of RA in numbers. Staff (8 nurses, 4 doctors) assessed the overall feasibility as 7, (range 4-9) on a numeric scale 0-10. Only one found the system laborious, 50% reported reduced need of appointments and 78% reported reduced need of phone calls.
Conclusions This automated cell phone based system may help monitoring of patients with early RA in circumstances of limited resources.
Disclosure of Interest None Declared