Background Recently, the effectiveness of monitoring disease activity in rheumatoid arthritis (RA) through patient reported outcome (PRO) based tele-health follow-up was tested in a randomized controlled trail, TeRA (1). The TeRA study evaluated the effectiveness of the tele-health follow-up but did not study how patients grasp this new form of disease control. Many studies on tele-medicine focus on the over-all patient satisfaction with tele-medicine follow-up, but gives limited insight into what drives patient satisfaction (2).
Objectives To explore the experiences of a PRO based tele-health follow-up from the perspective of patients with RA with a special attention on experiences of taking a more active role and assuming more responsibility in the disease control.
Methods The qualitative research strategy was Interpretive Description (3). From October 2015 to January 2016 we conducted individual semi-structured interviews with 15 patients with RA who had taken part of the tele-health follow-up. The selection of participants was purposive and participants with different sex, age, disease duration and severity were included. Age ranged from 28 – 77 years and disease duration from 4 – 41 years. The analysis of the interview transcripts was inductive with a constant comparative approach. First, we identified the main themes that could describe the participants' experiences. Subsequently, we constructed patient types that could explain different perspectives on the tele-health follow-up.
Results Five themes covered the participants' experiences with PRO based tele-health follow-up: “A flexible solution”, “Responsibility”, “Knowledge of RA”, “Communication and involvement” and “Continuity”. Two different types of personalities: “the keen patient” and “the reluctant patient”, represented opposite perspectives and preferences regarding the core value of and approach to the tele-health follow-up compared to usual out-patient care.
Conclusions In general, the participants had positive perceptions towards the PRO based tele-health follow-up and saw this as a flexible, time and resource saving solution. Disadvantages were mainly related to the missing face-to-face contact with health professionals. The two types of personalities, 'the keen patient' and 'the reluctant patient', contribute to the understanding of patients' different needs, wishes and abilities to take part in tele-health follow-up. Thus, our findings call for more insight of how tele-health follow-up could be integrated in routine clinical practice with a special attention on how to support “the reluctant” patient types.
De Thurah A, Stengaard-Pedersen K, Maribo T et al. A Tele-health Treatment Strategy for Tight Control of Disease Activity in Rheumatoid Arthritis: Results of the Non-inferiority Randomised Controlled Trail (the TeRA study). ClinicalTrials.gov Id: NCT02155894. Submitted 22.01.17. EULAR abstract number: EULAR17–2995.
LeRouge MC, Garfield JM, Hevner RA. Patient perspectives of telemedicine quality. Patient Preference and Adherence 2015; 9:25 – 40.
Thorne SE. Interpretive description. Left Coast Press, Inc. Walnut Creek. 2008. 1. edition.
Acknowledgements We are grateful to the participants who shared their experiences. We also thank an internal research foundation at Aarhus University Hospital for supporting this study.
Disclosure of Interest None declared