Automated Cell-Phone System Expedites Monitoring Early RA

Alice Goodman

November 13, 2012

WASHINGTON — An automated cell-phone system used for 6 months enabled clinicians to "red flag" patients with early rheumatoid arthritis (RA) who needed attention. It also allowed patients who were doing well on their medications to forgo clinic visits.

These findings from a small study were reported here at ACR 2012.

Since the study was completed, the automated cell-phone system has been expanded to a much larger population, according to study coauthor Tuulikki Sokka, MD, from the Jyväskylä Central Hospital in Finland.

"It is important to get patients with RA to remission as early as possible. We give them powerful medications and teach them compliance, but they need to be monitored to improve outcomes. Some studies suggest monitoring them once a month for the best outcomes," Dr. Sokka said during a press conference. "However, clinics may not have the resources for such frequent monitoring, and patients may have difficulty traveling to the clinic.... We wanted to study a simpler way to monitor them," she explained.

The automated system requires cell phones and the ability to text. It was implemented in 14 clinics in Finland; the data reported come from the first 137 patients. Hundreds of patients are now on this system, but hard data from the extended experience are not yet available.

Dr. Sokka said that the automated cell-phone monitoring is working very well. In a questionnaire, more than 90% of the 137 patients said their experience was positive; 96% felt confident, safe, and taken care of; and 98% said they would recommend it to other people.

At Jyväskylä Central Hospital, patients with early RA are scheduled for a visit 3 months after the first visit following diagnosis, then in 6 months, and then annually. This leaves patients vulnerable during the first 3 months they are prescribed medications, she said.

"When patients are diagnosed, we educate them and...register them for the cell-phone monitoring system. We kept the system simple and easy for patients to use," she noted.

Two weeks after diagnosis, they receive an automated phone call asking, "Are you taking your medications?" Two weeks later, another automated phone call asks, "Are you having any problems?" Two weeks after that, patients are asked to assess the severity of their RA on a scale from 0 to 10. Each of these questions can be answered by punching 1 key on the cell phone.

"If no problems are identified, the software continues to assess the patient automatically for the first 6 months. No nurse or doctor is needed," Dr. Sokka noted.

"If there are problems, an alarm signal sends an automatic SOS to the patient saying that the nurse will call within 2 working days, and a simultaneous email is sent to our nursing staff. The nurse evaluates whether we need to bring the patient back to clinic," she explained.

"We think this system will allow us to direct our resources in the clinic to the patients who really need them. We also think this may increase patient compliance, and long-term outcomes will improve if patients are under control in the first 6 months," Dr. Sokka stated.

"I am fascinated by this study," said Kelly Weselman, MD, a rheumatologist at WellStar Rheumatology in Atlanta, Georgia. "We currently have shortages of rheumatologists in the United States, and we need to be able to know how our patients are doing. This automated cell-phone system may be the wave of the future, with distant oversight between clinic visits."

"Currently, visits are generally at 3 months and 6 months, but with staffing shortages, a system like this is an additional link...between the patient and the healthcare provider. This is adjunctive, rather than replacing a visit to the doctor or nurse," she said.

Dr. Sokka has disclosed no relevant financial relationships. Dr. Weselman reports participating in the Sunstone Study, funded by Genentech, for the postmarketing surveillance of rituximab in RA patients.

ACR 2012: Abstract 375. Presented November 11, 2012.