Gossec, L., Servy, H., Soubrier, M., Joubert, J.M., Czarlewski, W., Combe, B., Berthelot, J.M., Wendling, D., Cantagrel, A., Dernis, E., Grange, L., Beauvais, C., Perdriger, A., Nataf, H., Dougados, M. (September 2016)
Background/Purpose: Electronic (e)-health is a rapidly evolving field. Interactive online services are available and may be useful for patients with chronic diseases such as rheumatoid arthritis (RA), but have not been properly assessed. Sanoia is a secure and independent patient e-health and mobile (m)-health platform, developed to allow self-assessment, storage of questions to ask physicians and self-monitoring of disease status. The platform offers a dedicated set of scores, patient-reported outcomes and information for diseases, including RA. The objective of the trial was to assess the effect of access to the Sanoia e-health platform on patient-physician interaction efficacy after 12 months.
Methods: This 12-month, French, multi-center, randomized controlled trial (NCT02200068) included patients diagnosed with RA, recruited by their tertiary care center physician. Patients were allocated to 2 groups: a) possibility of access to the Sanoia platform, or b) usual care (continuation of normal internet use without Sanoia access). Follow-up was performed over 12 months by a home-based e-CRF. Primary outcome was change over 12 months of Perceived Efficacy in Patient-Physician Interactions Questionnaire (PEPPI).1 The PEPPI-5 consists of 5 items, each starting with ‘‘How confident are you in your ability to…” (eg. “…know what questions to ask a doctor?’’). Patients rated each item on an 11-point scale; 0=not at all confident, 10=very confident. Total PEPPI-5 scores range from 0–50, with higher scores representing higher perceived self-efficacy in patient-physician interactions. Other outcomes measured included numeric rating scale (NRS) to assess perceived quality of care, and RA Impact of Disease (RAID) score to assess patient-perceived impact of RA. Analyses were non-parametric comparisons and used LOCF imputation on the intention-to-treat (ITT) population.
Results: Of 320 RA patients (159 vs 161, Sanoia vs usual care), mean (SD) age was 57.0 (12.7) years, mean (SD) disease duration was 14.6 (11.1) years and 253 (79.1%) were female. DAS28 was 2.65 (1.20), 54.1% were in DAS28 remission (<2.6), 216 (67.5%) were taking a biologic and 21.9% had previous therapeutic education sessions. 12-month data were available for 244 patients (76.0%). In ITT analyses, mean (SD) changes in PEPPI from baseline to 12 months were 38.6 (8.2) to 39.2 (8.0) (delta=+0.60 [5.52]) vs 39.7 (7.3) to 38.8 (8.0) (delta=-0.91 [6.08]) in Sanoia vs control group (p=0.01). Mean (SD) changes in quality of care NRS from baseline to 12 months were 8.2 (1.7) to 8.3 (1.6) (delta=+0.06 [1.44]) vs 8.2 (1.6) to 7.8 (1.9) (delta=-0.42[1.63]) in Sanoia vs control group (p=0.02). RAID changes did not differ between groups (data not shown).
Conclusion: In this randomized trial, giving RA patients access to the interactive Sanoia e-health platform led to a statistically significant, although small, improvement in patient-perceived patient-physician interactions and patient-perceived quality of care. This confirms the usefulness of an e-health intervention complementary to physician care in RA.
(publication) Gossec, L., Servy, H., Soubrier, M., Joubert, J.M., Czarlewski, W., Combe, B., Berthelot, J.M., Wendling, D., Cantagrel, A., Dernis, E., Grange, L., Beauvais, C., Perdriger, A., Nataf, H., Dougados, M. (September 2016). Access to an Active, Interactive Self-Assessment e-Health Platform Improves Patient-Physician Communication in Rheumatoid Arthritis: Results of a Randomized Controlled Trial Including 320 Patients over 1 Year [abstract]. Arthritis Rheumatol, 68(10).