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A new era of care in rheumatoid arthritis: The transition to virtual?

This story is intended for a range of audiences including healthcare professionals, patients, patient organisations, policy makers and healthcare decision makers

For nearly 20 years, AbbVie has been dedicated to understanding the needs and improving lives for people living with rheumatic diseases. Our continued research and engagement with the patient and healthcare community has helped transform care for many patients who suffer from the significant and debilitating effects of rheumatic diseases. Patients continue to inspire our every step as we pursue the goal of improving the patient experience from diagnosis to remission. By looking at how new forms of digital care can be utilised, we’re striving to ensure that changes to care experiences and practices don’t interfere with patients’ daily lives.

As part of our continued commitment to supporting the future of rheumatoid arthritis (RA) care, we have been actively involved in this year’s British Society for Rheumatology (BSR) annual conference which took place virtually between 26th and 28th April 2021. The conference provided a fantastic platform to hear from high profile experts on the latest advances and challenges facing RA care right now.

At BSR, AbbVie hosted the RA innovation session ‘Hospital to home: Real-world experience of virtual care from patients and clinicians’. The session invited discussion from Ailsa Bosworth, MBE, National Patient Champion and Founder of the National Rheumatoid Arthritis Society (NRAS), Julie Begum, Lead Nurse in Rheumatology from Bedfordshire Hospital and Dr Stuart Kyle, Consultant Rheumatologist from Northern Devon Healthcare NHS Trust. Together, they explored the move from face-to-face consultations to virtual and telephone consultations, focusing on the positives and challenges brought about by this.

“We are in the midst of a paradigm shift in rheumatology care, driven by the obligated uptake of remote consultations and increased importance of ePROMs (electronic patient-reported outcome measures)” said Stijn Van Haaren, Medical Lead for Rheumatology at AbbVie. “It’s impressive to see how health care providers (HCPs) and patients have adapted to virtual consultations which have now become part of regular care, bringing many advantages. I have heard that through virtual consultations there has been a decrease in personal time lost for patients to attend appointments, where previously patients would be taken out of the workforce for half a day or more. Video consultations can be very practical and will provide great opportunities in future care. As an example, HCPs can share their screen with patients to talk them through results and information about their care. Consultants have even been comfortable adjusting treatment in some patients based on the information from virtual consultations.”

As many patients and HCPs embrace this new form of care, it is essential to understand the potential challenges. Trish Cornell, Rheumatology Nurse Consultant at AbbVie said, “As Ailsa said in the innovation session, HCPs start assessing their patients from the moment they walk in the room; do they look unhappy? Are they walking slower or awkwardly? These visual cues can be lost in virtual consultations and there is risk that things such as depression, anxiety or intimacy discussions, which can be more easily teased out in face-to-face consultations, may be missed virtually. Video is generally more favourable to telephone consultations in allowing more flexibility in seeing nonverbal cues and patients showing their physical problems more easily. There are also practical barriers in virtual care; access to appropriate equipment and how comfortable or familiar people are with using these platforms.”

In response to the COVID-19 pandemic many processes have been successfully simplified and streamlined. New ways of working have been rapidly adopted in areas such as triaging patients, virtual consultations, digital tools to monitor outcomes and wider use of patient education resources to support self-management (e.g. NRAS is developing resources such as 'how to make the best of remote consultations') and Shared Decision Making. “As attention now turns to delivering quality care in the ‘COVID era’ these positive changes must be taken forward and built into the inevitable restructure of rheumatology care pathways, exploiting the advantages of hybrid care with patients being seen both virtually and face-to-face. Future success will depend on whether we manage to triage the right patient to a live consultation for appropriate care, so no patient is left behind and all patients are given equal opportunity to strive for complete remission of their disease,” said Trish.

The COVID-19 pandemic has served to exacerbate pressures that were already facing rheumatology services in the UK; long delays in access to services and treatment leading to regional variation in outcomes, and RA remission rates that have fallen behind comparative European countries, at 26% in the UK compared to 62% in France.1 While the NHS response has been exceptional, we have also seen patient groups and communities rise to new heights to support patients and each other during these uncertain times. Every person and organisation working across healthcare has a role to play in ‘re-starting’ the NHS. “AbbVie is championing the hybrid approach of virtual and face-to-face consultations” said Stijn. “We are exploring remote monitoring solutions for RA patients to effectively capture patient-reported outcomes (PROs) while freeing up busy face-to-face clinic time. Patients are taking a new role in their care in line with the NICE standards to reduce patients’ use of precious NHS resources. There is an increased importance for patients to be proactive about understanding their symptoms and initiating conversations about their care. We support clinician and patient education around DAS-28 self-joint count and NRAS’s Right Start programme, where HCPs signpost patients to self-management tools and resources. However, we also understand and advocate that those patients who need to be seen in person are able to do so and at the right time. We will continue to work with HCPs and the patient community to support self-management and care, and to empower more effective patient and clinician dialogue around treatments and treatment goals, such as remission.”

BSR Annual Conference 2021 sessions (26-28th April 2021) are available on demand to view via BSR for a period of three months. Please note, some sessions are for healthcare professionals only.

Reference: 1Bergstra SA, et al., Inequity in access to bDMARD care and how it influences disease outcomes across countries worldwide: results from the METEOR-registry. Ann Rheum Dis. 2018;77:1413-20

Date of preparation: April 2021
Job code: UK-IMMR-210015