Towards Telemonitoring in Immune-Mediated Inflammatory Diseases: Implementation of a Mixed Attention Model.

BACKGROUND:Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to adjust their effects and improve patient quality of life. Many times, delays in outpatient consultations or patient´s difficulties in keeping appointments make such close follow-up problematic. For this reason, it is very important to have fluid communication channels between patients and health professionals. In this context, the implementation of telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients to self-manage certain aspects of their disease. So, this fact could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of problems or difficulties that would otherwise go unnoticed. OBJECTIVE:The main objective is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and to evaluate whether its implementation improves clinical outcomes compared to conventional follow-up. METHODS:This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and Spondylarthritis (SpA) from five Spanish Hospitals. Patients will be followed-up by the MAM protocol, which is a care model that incorporates the use of digital tool consisting of a mobile application (App) that patients can use at home and that professionals can review asynchronously to detect incidents and to follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analogue scale for pain and electronic patient reported outcome reports (ePROs) will be collected for all subjects. In the MAM group, these items will be self-assessed both by the mobile App and during face-to-face visits with rheumatologist, who will do the same for patients included in the traditional care model. Patients will be able to report any incidence related to their disease or treatment through the mobile App. RESULTS:Recruitment of participants will start in March 2024 and will continue until April 2025. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. CONCLUSIONS:The main objective of this article is to provide a detailed description of the development and implementation of a digital solution, in this case a MAM, with the aims of having both economic and psychosocial impact on our healthcare system by fostering better and tighter control of RMDs. CLINICALTRIAL:NCT06273306.