PARE0031 AN MHEALTH TOOL FOR SHARED DECISION MAKING FOR PATIENTS WITH RHEUMATISM AND ARTHRITIS
Authors: Y. Koumpouros, A. Pappa
Journal: Annals of the Rheumatic Diseases (2020)

Background: Patient empowerment is a key element of patient-centred healthcare according to WHO. In the same direction, the Institute of Medicine in the United States supports actions to engage patients in their health care decision in a new patient-centered care model. Patient-centred care models have demonstrated better quality of care as well as potential long-term cost-efficiencies. However, nowadays, many patients are still struggling to become equal partners in care. Patients with chronic conditions, such as rheumatoid arthritis, are often referred to as the most under-used resource in the health system. Shared decision making is a collaborative process enabling a clinician and patient to participate jointly in making a health decision about the treatment having discussed the options, benefits and harms, while considering also the patient’s values and experiences. Objectives: The objective of the current research was to design a tool that will facilitate the shared decision making regarding the treatment approach, based on real life evidences from the patient. The focus of the application is on the pain assessment of patients suffering from rheumatism and arthritis. The proposed solution utilizes the latest technological innovations to support patients and clinicians on their decisions and assessment strategy on a more accurate base. Methods: The design process followed a user-centered approach by involving a multidisciplinary team of experts (an mHealth expert, a behavioural scientist, and two physicians). An iterative design process focused on the different end-users (patients and clinicians) and their actual needs on the topic concerned. In each phase, the experts involved the end-users to create a highly usable tool. The aim was to capture and address the whole user experience. An evaluation phase took place for three months. Results: The design team brought the users into every stage of the design process. Twenty patients and three physicians (one pathologist, one general surgeon and an expert in pharmacology and clinical pharmacology) participated and evaluated the modules implemented. The final solution consists of an application running on Android operating system in any smart phone. The final application supports the patient to enter all necessary information about: (i) the pain he/she is feeling, (ii) the medication he/she is receiving, and (iii) his/her life style. Conclusion: After a three months period of continuous use of the application from the participants during the evaluation phase, they reported very encouraging results. In terms of usage, the patients found it user friendly, easy to learn, easy to use, and easily accessible. They also consider it really useful in order to keep track of their progress and assess the treatment and medications they receive relevant to the pain they feel. The physicians involved in the evaluation of the application found it very useful and with significant potential for daily use by clinical staff to evaluate the therapies given to their patients. All users concluded that the developed app can help towards a more accurate and acceptable treatment based on shared decision, exploiting the collected evidences. References: [1]Angelmar R, Bermann BP. Patient empowerment and efficient health outcomes. Financing sustainable healthcare in Europe. 2007:139–162. [2]Hargraves IG, Montori VM, Brito JP, et al. Purposeful SDM: A problem-based approach to caring for patients with shared decision making. Patient Education and Counseling. 102(10), 2019, p. 1786-1792. [3]Légaré F, Stacey D, Brière N, et al. Healthcare providers’ intentions to engage in an interprofessional approach to shared decision-making in home care programs: a mixed methods study. J Interprof Care 2013; 27: 214-222 [4]McWilliams DF, Walsh DA. Pain mechanisms in rheumatoid arthritis. Clin Exp Rheumatol. 2017 Sep-Oct;35 Suppl 107(5):94-101. [5]National Research Council. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press, 2001. [6]Hoffmann TC, Légaré F, Simmons MB, et al. Shared decision making: what do clinicians need to know and why should they bother? Med J Aust 2014; 201 (1): 35-39. Disclosure of Interests: None declared