P115 Remote clinical management: incorporating electronic assessment of patients with rheumatic diseases into standard clinical pathways and comparison to in-person assessment

Abstract

Abstract Background/Aims The aim of this project was to develop generalisable digital solutions to deliver safe, efficient and effective care for patients with long-term rheumatic conditions. We have previously demonstrated that this method is feasible and acceptable to patients with RA and AxSpA. We evaluated the outcomes of remote assessment across a further range of conditions; making comparisons with corresponding in-person assessments. Methods We developed online questionnaires, using readily available software, to conduct remote assessments in 806 patients awaiting follow-up. Questionnaires contained: measures of disease activity; patient reported outcomes; patient preferences regarding the urgency and type of appointment required; and any other recent problems or changes in medication highlighted by the patient. The information was imported into a bespoke clinical database allowing clinicians to conduct an asynchronous assessment, integrated within electronic health records (EHR). Report letters were sent to patients and their GP. EHRs were reviewed in a subset of patients, requiring urgent in-person assessments (within 1-month) following remote assessment, to evaluate overall agreement with in-person assessment of disease activity and treatment changes. Chi-square test was used to investigate for significant differences by condition. We defined “stable” disease as patients classified as in remission or partial remission, on or off immunosuppressive therapy. Results Table 1 summarises all the patients assessed remotely, by condition, and subsequent follow-up requested. Agreement between remote and in-person assessment was evaluated in 56 patients (25 RA; 14 PsA; 17 AxSpA). Agreement between remote and in-person assessment was present in 21/25 (84%), 9/14 (65%) and 12/17 (71%) of patients with RA, PsA and AxSpA respectively, p = 0.35. Treatment changes were made in 21/25(84%), 9/14(65%), 11/17(65%) of patients with RA, PsA and AxSpA respectively, p = 0.26). Conclusion We have developed and implemented a system of remote clinical management for patients with rheumatic conditions. Following remote assessment only 284/806 (35%) required a subsequent in-person assessment and 351/806 (44%) had stable disease. Concordance with in-person assessment was highest for patients with RA, but not significantly different to outcomes for PsA and AxSpA. Further work is needed to validate this mode of assessment, including patients with vasculitis/CTD and those declared as having “stable” disease. Disclosure A. Soni: None. J. Jackman: None. S. Manderson: None. L. Saldana Pena: None. J. Barrett: None. R. Luqmani: None.