Remote monitoring of patients with rheumatoid arthritis: a mixed methods evaluation across six hospitals in London, UK

Kathryn Watson; Helen Sheldon; Elena Pallari; Nikita Arumalla; Rachel R Olive; Olga Boiko; Camille Aznar; Emma-Jayne Adams; Ailsa Bosworth; Len Demetriou; Melanie Martin; Mary-Ann Palmer; Polly Sinclair; Emily J Smith; Nick Sevdalis; Andrew Walker; Toby Garrood

doi:10.1093/rheumatology/keae112

Remote monitoring of patients with rheumatoid arthritis: a mixed methods evaluation across six hospitals in London, UK

Rheumatology (Oxford). 2024 Feb 24:keae112. doi: 10.1093/rheumatology/keae112. Online ahead of print.

Authors

Kathryn Watson¹, Helen Sheldon², Elena Pallari², Nikita Arumalla³, Rachel R Olive¹, Olga Boiko¹, Camille Aznar², Emma-Jayne Adams, Ailsa Bosworth⁴, Len Demetriou¹, Melanie Martin³, Mary-Ann Palmer⁵, Polly Sinclair², Emily J Smith³, Nick Sevdalis¹, Andrew Walker², Toby Garrood³

Affiliations

¹ Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
² Health Innovation Network, London, UK.
³ Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁴ National Rheumatoid Arthritis Society, Maidenhead, UK.
⁵ Patient Author from Guy's and St Thomas' NHS Foundation Trust, London, UK.

PMID: 38402509
DOI: 10.1093/rheumatology/keae112

Abstract

Objectives: This study evaluated the scale-up of a remote monitoring (RM) service, capturing monthly Rheumatoid Arthritis Impact of Disease scores and patient-generated text messages, for patients with rheumatoid arthritis (RA; in remission or with low disease activity) attending routine outpatient clinics across six hospitals. We explored patients and staff experiences and implementation outcomes.

Methods: A pragmatic, mixed methods approach was used, with active patient involvement throughout. We undertook a rapid review, analysed service-level data, and conducted a patient survey and patient and staff interviews, informed by the Capability, Opportunity, Motivation, Behaviour (COM-B) and Exploration, Preparation, Implementation, Sustainment (EPIS) theoretical frameworks.

Results: The review included 37 articles, covering themes of patient and clinician acceptability, engagement, feasibility and clinical impact. Service-level data (n = 202) showed high levels of patient engagement with the service. The patient survey (n = 155) showed patients felt the service was easy to use, had confidence in it and felt it improved access to care. Patient interview (n = 22) findings mirrored those of the survey. Motivating factors included increased responsiveness and ease of contact with clinical teams. Views from staff interviews (n = 16) were more mixed. Some implementation barriers were specific to roll-out sites. Prioritisation of staff needs was emphasised.

Conclusion: Patients were positive about the service and engagement was high. Staff views and engagement were more mixed. Results suggest that equal levels of patient and staff engagement are required for sustainability. These findings further our understanding of the implementation challenges to scaling RM interventions for patients with RA in routine care settings.

Keywords: implementation; remote monitoring; rheumatoid arthritis; service evaluation.