Pos0475 factors influencing acceptance and persistence of electronic patient-reported outcomes collection in a real-world clinical setting

Background Rheumatoid arthritis (RA) has a relapsing-remitting nature, making it difficult to predict when patients should be seen. Collection of patient-reported outcomes (PROs) effectively communicates patients’ disease experiences. However, certain factors could impact the utilization and persistence of PROs collection. Objectives To explore the impact of demographic, clinical parameters on acceptance and long-term utilization of smartphone application (app) for electronic PROs (ePROs) collection. Methods A retrospective analysis of anonymized data collected through app as part of routine care delivered in outpatient clinic at North Bristol NHS Trust. Patients agreed to use a smartphone-based diary (LivingWith) to record disease activity between appointments by reporting weekly RAPID3, HAQ every 28 days. 28 tender/swollen joint count (JC) could also be assessed. Patients with ≥1 record were analyzed, including all reports until last follow-up. Disease activity and disability categories were defined on baseline RAPID3, HAQ scores [1,2]. Mean and SD or median and IQR were reported. T-test, Mann–Whitney U, Kruskal–Wallis tests were used. Kaplan-Meier analysis was produced. Statistical tests were performed using Stata 16.1 (StataCorp, USA) and RStudio V.1.4.1717. Results 306 (81.4%) patients had completed both questionnaires, 16.2% just RAPID3, and 2.4% only HAQ. 74% of participants were women with mean age 56±14. 27(6.7%) of patients didn’t provide either RAPID or HAQ and assessed only 28 JC. The median number of completed records for RAPID3 and HAQ was 10 [4;31] and 4 [2;10] respectively. The median number of days following registration when the first ePRO was completed was 9 [0;17] for RAPID3 and 4 [0; 32.5] for HAQ. The median time between ePRO completion was 13 days [8;29] for RAPID3 and 29 days [3; 483] for HAQ. The median RAPID3 score was 10.5 [5.6;15.9] and HAQ score 1.02 [0.5;1.625]. The median period [CI] for patients’ app engagement for RAPID3 was 67 weeks [55;83], for HAQ 48 weeks [36;60] (Figure 1). Demographic parameters at the registration as well as baseline disease activity and disability categories had no clear relationship with patient engagement in app use (Table 1). Table 1. The impact of demographic and clinical factors on the persistence of ePROs collection. Baseline factor Мах еlapsed days Median [IQR] ePROs number Median [IQR] Average days between ePROs Median [IQR] Rapid3 HAQ Rapid3 HAQ RAPID3 HAQ Female (n=227) 270[57;560] 167[0;471] 9 [4;29] 4 [1;10] 14 [8;31] 28 [0;47] Male (n=79) 315[114;595] 259[28;504] 16 [5;44] 5 [2;11] 11 [8;24] 29 [14;53] p-value 0.41 0.20 0.023 0.18 0.21 0.26 Age, years: <50 (n=102) 243[63;511] 158 [22;447] 8[4;20] 4 [2;8] 16 [10;34] 33 [10;50] 50-59 (n=72) 265[53;543] 157[0;476] 8 [4;28] 4 [1;11] 15 [7;34] 46 [28;46] 60-69 (n=75) 281[99;610] 224[13;524] 14[4;43] 5 [2;11] 12 [7;29] 29 [7;48] >70 (n=57) 379[11;595] 201[2;450] 17[5;59] 4 [2;11] 10 [7;24] 26 [1;43] p-value 0.58 0.74 0.04 0.34 0.07 0.57 RAPID3: <2.0 (n=28) 280[39;616] 210[0;539] 9[3;36] 5 [1;13] 16 [8;30] 27 [0;41] 2.1-4.0 (n=19) 486[141;602] 382[110;602] 19[5;69] 7 [4;16] 9 [8;20] 36 [22;45] >4.0 (n=259) 262[63;546] 172[4;447] 9[4;30] 4 [2;10] 13 [8;30] 28 [2;49] p-value 0.44 0.24 0.15 0.16 0.59 0.60 HAQ: ≤1.0 (n=153) 262[77; 560] 175[0;532] 11[4;31] 4 [1;11] 13 [8;28] 29 [0;47] >1.0-≤2.0 (n=121) 329[109;607] 212[21;437] 9[5;33] 4 [2;11] 15 [8;33] 30 [11;50] >2.0-≤3.0 (n=32) 193[35;548] 42 [0; 364] 8[3;23] 2 [1;6] 12 [7;18] 14 [0;32] p-value 0.38 0.15 0.73 0.12 0.17 0.07 Figure 1. Patient engagement in the app. * Time in weeks Conclusion PROs collection provides valuable information on effectiveness and tolerability of health interventions. Patients’ engagement in reporting decreases over time, suggesting the importance of reinforcement. Neither age, gender nor baseline clinical status appeared to be related to patient reporting persistence. References [1]Pincus T., Swearingen C.J., Bergman M. et al. J Rheumatol, 2008; 35(11): 2136-47. [2]Bruce B, Fries J.F. Health Qual Life Outcomes. 2003; 9; 1:20. Acknowledgements: NIL. Disclosure of Interests Iuliia Biliavska: None declared, Erik Lenguerrand: None declared, Jon Tobias: None declared, Philip Hamann Consultant of: Dr. Hamann has provided consultancy for and has options and a limited royalty agreement with Living With Ltd Software Company for the development of the smartphone application - LivingWith and received honoraria from Gilead Pharmaceuticals for the production of training materials on remote monitoring for patients with arthritis.