Researchers in China have developed a new online consultation tool for patients with rheumatic disease, which they hope will strengthen interactions between doctors and patients and lead to more efficient management of chronic illness. Their work was highlighted on Monday at the 2017 annual meeting of the American College of Rheumatology (ACR) and the Association of Rheumatology Health Professionals (ARHP).
According to the research team, more than 100 million people in China have rheumatic disease, but the country has only 5,000 rheumatologists to manage their care, and most are located in major cities.
“Most [patients] must travel long distances to seek rheumatologic care at a hospital, and they must stay in nearby hotels and endure long waits for a visit with the clinician,” said Fei Xiao, MD, chief executive officer of Cinkate Corporation and a lead author of the study. “It is not uncommon for most Chinese rheumatologists to have to see up to 60 to 100 patients daily. Because of the large volume of patients who go to major hospitals for regular clinical care, physicians may only spend three minutes on average with each patient. This limits the time to do objective disease activity evaluations.”
To address the issue and improve patient management, Dr. Xiao and his colleagues from multiple Chinese institutions developed the Smart System of Disease Management (SSDM), a series of applications based on clinical data that includes online consultation via a mobile app.
SSDM includes a doctor-patient interface, as well as a system for patients to perform self-assessment with the Disease Activity Score of 28 joints and the Health Assessment Questionnaire (HAQ). The system also allows patients to enter data about medications, adverse events and laboratory test results, then submit all data to an authorized physician. Subsequently, a rheumatologist may accept a request for follow-up and consult with a patient via text or voice through the SSDM.
In previous research, the team trained patients with rheumatoid arthritis to use the SSDM and found that subjects were able to manage some facets of their own care. New this year at the ACR/ARHP conference, the researchers presented findings that the SSDM is economically beneficial and satisfactory to patients with rheumatic disease.
The study sample included 403 rheumatologists and 4,002 patients with RA, lupus, ankylosing spondylitis, gout, osteoarthritis, Sjögren’s syndrome or other rheumatic diseases. From February 2015 to June 2017, the physicians provided implemented the online educational and training program and helped patients to download the mobile application.
Overall, 35.3 percent of patients who received online consultations lived in a different city from the rheumatologists. The researchers compared the costs of the online consultations with the costs that would have been incurred for consultations plus registration fees, medical expenses, the average cost of transportation, accommodations, meals and lost wages. They found that the cost of in-person consultation would have been 6.61 times higher than the cost of online consultation, including a savings of 84.86 percent for the patients.
The researchers also surveyed the patients to evaluate their satisfaction with the SSDM, and 66.35 percent reported their experience as “very satisfying.”
The authors said the model represents a paradigm shift for management of chronic disease because it empowers patients, helps doctors enhance outcome-driven care, and advanced real-time data for scientific research and publication. They encouraged replication of the SSDM model in other chronic disease states.