Background From 2015 to 2018, the Swiss Clinical Quality Management in Rheumatic Diseases registry (SCQM) offered two mobile apps, iDialog and COmPASS, allowing patients to track disease and health status between rheumatology visits. Both apps are linked to the registry database, providing patients and physicians extra information to guide disease management decisions.
Objectives To investigate the effect of SCQM app use on shared decision making (SDM) and disease management.
Methods Patients were administered a cross sectional survey about satisfaction with SDM , disease management, and app use (February-December 2018). Patients’ demographic data and longitudinal data on disease status, health status, and medication use was extracted from the SCQM database.
Analyses included patients diagnosed with rheumatoid arthritis (RA), psoriatic arthritis (PsA), or axial spondyloarthritis (axSpA) who had 1) used an SCQM app for at least 6 months and discussed app data with their physician (app + discussion group), 2) used an SCQM app for at least 6 months and did not discuss app data with their physician (app only group), or 3) did not use any SCQM app (non-app users).
We compared the 3 groups by conducting logistic regressions for the following dichotomized outcomes: maximum satisfaction with SDM and physician following the evolution of the disease, low disease activity at the most recent SCQM visit, disease activity improvement in the last year of followup, and treatment intensification (adding/increasing the dose of a disease-modifying antirheumatic drug) in the last 6 months of followup. Regressions were weighted using multinomial propensity scores to balance differences in baseline characteristics between the 3 groups.
Results 1924 patients were included in the analyses. App users were younger than non-app users (Table 1). In adjusted analyses (Table 2), satisfaction rates were higher in the app + discussion group (p<0.05) compared to non-app users, but not for the app only group. The app only group had higher rates of treatment intensification in the last 6 months of followup (p=0.02) compared to non-app users. Although the app only and app + discussion groups had higher adjusted rates of other disease management outcomes compared to non-app users, the effects were not statistically significant.
Conclusion App users who communicated with their rheumatologist about their app data were more satisfied with their physicians than app users who did not communicate about their app data and non-app users. Provision of apps that increase the frequency of disease monitoring may have limited impact on patient satisfaction with care and disease management processes without integration of app use into existing care processes.
References  Elwyn G, et al. Developing CollaboRATE: A fast and frugal patient-reported measure of shared decision making in clinical encounters. Patient Education and Counseling2013;93:102-107.
 Coates LC, et al. Defining minimal disease activity in psoriatic arthritis: a proposed objective target for treatment. Ann Rheum Dis2010;69:48-53.
#Test of difference between groups
*Low disease activity was defined as DAS28 < 3.2 in RA and BASDAI ≤ 4 in axSpA. In PsA, it was defined as fulfilling at least 5 of 7 criteria for minimal disease activity .
Disclosure of Interests Yomei Shaw Grant/research support from: Unrestricted grant from MSD, Delphine Courvoisier Grant/research support from: has received an unrestricted grant from MSD for this study, Consultant for: has received consulting fees from BMS, Pfizer, AB2 Bio and Janssen., Paid instructor for: Janssen, Almut Scherer Grant/research support from: Almut Scherer is an employee of SCQM, which receives funding from AbbVie, Celgene, iQONE, Lilly, MSD, Novartis, Pfizer, Roche, Sandoz, Sanofi Genzyme, and UCB., Consultant for: Consultant for Pfizer, MSD, and AbbVie, Adrian Ciurea Consultant for: AbbVie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Speakers bureau: Abbvie, Celgene, Janssen-Cilag, MSD, Eli Lilly, Novartis, Pfizer, UCB, Thomas Lehmann: None declared, Veronika Jaeger Grant/research support from: Has received an unrestricted grant from AbbVie to support the creation of the COmPASS II app, Ulrich Walker Grant/research support from: Unrestricted grant from AbbVie for the creation of the COmPASS II app, Axel Finckh Grant/research support from: Bristol-Myers Squibb, Pfizer Inc, Consultant for: AbbVie, A2Bio, Bristol-Myers Squibb, MSD, Roche, Pfizer Inc, and UCB
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