May 15, 2019
By: Julie Gould
Kaleb Michaud, PhD, and Elizabeth Mollard, PhD, both from the University of Nebraska Medical Center, recently spoke with us and explained why the use of mobile applications among patients with rheumatoid arthritis have the potential to reduce flares, increase adherence to medications, and lengthen the interval between visits to the rheumatologist.
First, please tell us a little about yourself.
Dr Michaud: I’m an Associate Professor here at the University of Nebraska Medical Center in the College of Medicine and Co-Director of Forward, The National Databank for Rheumatic Diseases. I am passionate about learning from patients with rheumatic diseases such as rheumatoid arthritis (RA) about all aspects of their health and quality of life are affected by these diseases and the subsequent conditions and issues that come from chronic pain, inflammation, medications, and health care interventions. Learning from patients directly helps provide greater context for safety, treatment effectiveness, quality of life and economic burden. While there are more effective treatments now compared to twenty years ago, there are still many barriers to access and adherence that could be improved through newer technology use in addition to being able to better observe how a patient is actually doing.
Dr Mollard: I am an assistant professor at the University of Nebraska Medical Center College of Nursing. I conduct research on technology use for health care intervention and delivery.
Recently, technology has begun to play a major role in health care. How has technology, such as mobile applications improved the health care and patient outcomes?
Technology can be used as a valuable tool to help patients manage their own care. Mobile devices can help remind people to be adherent to their medications, track symptoms and treatments, and learn more about their overall health. By gathering data on their own health patients become more in tune with what works and what may need to be changed. It can also help with communication between the patient and their health care providers, who are, more-or-less, providing help/advice for the patient’s self-management of their conditions.
How do mobile apps improve self-management of diseases such as Rheumatoid Arthritis?
RA is an illness that causes symptoms anytime and anywhere. Mobile self-management apps can empower a patient to track symptoms and treatments and tools to potentially identifying triggers. Gathering data on their own health helps a patient make behavioral or lifestyle changes that may improve their symptoms and learn more about what helps/hurts.
Is there a learning curve to understanding how to use these mobile apps among both patients and doctors? How is the learning curve addressed?
All technology has a learning curve, and ultimately the best way to address this is on an individual basis. The learning curve is greater with physical function decline from age and arthritis and individual patients may need additional help with accessibility due these limitations. Both patients and physicians have limitations on how much time they need to learn a new app especially one that may not be available or usable a few months later. Instead of using the latest “hotness”, they need to know what they’re using is not only intuitive to use, but feels useful for the longer term.
Briefly describe how the use of a mobile app for rheumatoid arthritis impact the cost of care. Are patients having fewer in-office visits?
This hasn’t been well studied and will be important to do. Theoretically, using a mobile app can help improve self-management behaviors which have been greatly associated with improving health. For patients with RA these apps have the potential to reduce flares, increase adherence to medications and lengthen the interval between visits to the rheumatologist. We don’t think the goal is to reduce visits since long-term followup is expected, but have the office visits be more productive with the brief amount of time allowed.
Overall, how were patient-reported outcomes impacted by use of a mobile app?
In our pilot study we saw improvement in qualities that identify a patient feels more confident in managing their own care (self efficacy in managing symptoms and patient activation), and promising trends towards reduction in pain and disability. Even with an app that wasn’t available long term, it made us feel more positive about using them in the future.
What are the major takeaways from your study? What can clinicians as well as payers learn from the findings?
The big takeaway is that self-management mobile apps have the potential to empower patients and improve their health. We suspect that these tools can and will grow in usefulness for patients self-care and improving the patient’s relationship with their clinicians.
We’re excited to help develop and test the next set of tools/apps that can help patients to improve their clinical and overall health outcomes!
Mollard E, Michaud K. Mobile Apps for Rheumatoid Arthritis: Opportunities and Challenges [published online May 2019]. Rheum Dis Clin North Am. 2019;45(2):197-209. doi: https://doi.org/10.1016/j.rdc.2019.01.011