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Access to an Active, Interactive Self-Assessment e-Health Platform Improves [...]

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.


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