THU0155 PATIENT ADHERENCE WITH A SMARTPHONE APP FOR DISEASE MONITORING IN RHEUMATOID ARTHRITIS
Authors: Daniel Solomon, Fengxin Lu, Chang Xu, Joshua Colls, Dong Hyun Suh, Meredith Murray, Cassandra Corrigan, Yvonne Lee
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Patients increasingly are asking for tools to improve self-management. Electronic patient reported outcomes (ePROs) transmitted digitally allow patients to both communicate with their clinicians between visits and help track their own disease activity. While several tools have been developed in rheumatology, few data have been reported regarding patient adherence. <h3>Objectives:</h3> To examine patient adherence to a smartphone app for rheumatoid arthritis (RAapp). <h3>Methods:</h3> We developed a smartphone app to deliver daily disease assessments to patients with RA (RAapp). The app was tested as part of a randomized controlled trial examining the potential clinical benefits of RAapp compared to a wait-list control. These analyses focus only on the adherence of patients who received RAapp and completed the 6-month trial. We recruited RA patients from the rheumatology practice at a large academic medical center in the US. Patients with at least 6weeks of stable DMARD use who were at least 18years of age were required to give written informed consent, be fluent in English, and have a smartphone with an iOS or android operating system. RAapp was downloaded by patients through a password protected link on to the patient's phone after consent. Patient's received daily notifications regarding disease assessments, including disease activity (RADAI), function (MDHAQ), pain (PROMIS), fatigue (PROMIS), sleep (PROMIS), and depression (PROMIS). The current set of analyses focused on adherence to RAapp, overall, by scale, and over the 6 months of the trial. We examined adherence to RAapp over the duration of the study and examined factors related to adherence using mixed regression models. Factors tested included patient age, sex, educational attainment, and baseline CDAI. <h3>Results:</h3> 75 patients received RAapp and have data included in these analyses (5 patients are in the last month of follow-up). 60 (80%) were female; age breakdown was 24% &lt; 45 years, 49% 45-64 years, and 27% 65 years and over; and educational attainment was 19% high school, 59% college, and 23% beyond college. Baseline CDAI demonstrated 20% in remission, 45% low, 24% moderate, and 11% high disease activity. During the 6-month study, median adherence to the RAapp daily questionnaires was 81.6% (interquartile range 48.4% to 92.3%). Broken down by the type of questionnaire, median adherence was: disease activity 79.8%; pain 80.8%; mood 76.2%; function 79.3%; fatigue 77.0%; and sleep 77.8%. Adherence to the daily questionnaires was highest in the first month but decreased a small amount each of the following months (see <b>Figure</b>, p for trend &lt; 0.001). The only significant predictor of higher adherence was age 65 or over (p = 0.04). High baseline CDAI was associated with a lower adherence but was not statistically significant (p = 0.07). <h3>Conclusion:</h3> We developed and tested an ePRO app for RA (RAapp). Among a large group of patients, adherence to the app was good but declined slightly over time. There was no substantial variation in adherence with different ePRO scales. Older age was the only significant predictor of adherence. <h3>Disclosure of Interests:</h3> Daniel Solomon Grant/research support from: Abbvie, Amgen, Genentech, Janssen, and Pfizer, Fengxin Lu Grant/research support from: Pfizer, Chang Xu Grant/research support from: Pfizer, Joshua Colls Grant/research support from: Pfizer, Dong Hyun Suh Grant/research support from: Pfizer, Meredith Murray Grant/research support from: Pfizer, Cassandra Corrigan Grant/research support from: Pfizer, Yvonne Lee Shareholder of: Express Scripts, Grant/research support from: Pfizer