Enablers and Challenges of Remote Monitoring in Stable Axial Spondyloarthritis

Overview

This qualitative study explores the facilitators and barriers to implementing a remote care monitoring model (PROMise) for stable axial spondyloarthritis (axSpA) patients in Singapore. Using the Consolidated Framework for Implementation Research (CFIR), insights from patients and healthcare professionals were gathered to inform sustainable adoption strategies.

Background

Axial spondyloarthritis is a chronic inflammatory disease affecting the spine and pelvis, often diagnosed in young adults, with prevalence ranging from 0.3% to 1.4%. It significantly impacts patients' functional status and quality of life, necessitating regular monitoring through patient-reported outcome measures (PROMs) like BASDAI. Traditional in-person rheumatology visits impose financial and logistical burdens, prompting exploration of remote monitoring approaches to maintain care quality while reducing costs and inconvenience.

Data Highlights

The PROMise model proposes automated remote monitoring of stable axSpA patients (BASDAI <4) via laboratory tests and PROMs completed at home, with algorithm-driven scheduling of follow-ups. Patients will have at least one annual in-person rheumatology visit. The model aims to maintain patient outcomes and experience while optimizing healthcare resource utilization.

Key Findings

• Remote monitoring via PROMs and lab data can reduce healthcare costs and patient burden without compromising quality-adjusted life years, as shown in prior studies.
• Implementation of the PROMise model requires addressing multiple domains including innovation characteristics, inner and outer settings, individual attitudes, and process strategies per CFIR.
• Engagement of both patients and healthcare professionals is critical to identify local contextual barriers and facilitators for adoption.
• Automated assessment and scheduling can streamline care but must ensure patient safety and maintain at least annual in-person evaluations.
• Implementation science frameworks like CFIR and ERIC provide structured approaches to tailor strategies for successful integration into clinical practice.

Clinical Implications

Clinicians managing stable axSpA patients may consider integrating remote PROM-based monitoring to reduce visit frequency and associated costs while maintaining disease control. Successful adoption depends on addressing local implementation barriers and ensuring patient and provider engagement. This approach could optimize resource use and improve patient convenience without sacrificing care quality.

Conclusion

The PROMise remote monitoring model for stable axSpA patients holds promise for enhancing care delivery efficiency. Applying implementation science frameworks is essential to navigate challenges and enable sustainable integration into routine clinical practice in Singapore.

Related Resources & Content

1. Hermans et al. 2023 -- Remote monitoring in axial spondyloarthritis: a randomized controlled trial
2. Smits et al. 2022 -- Patient and healthcare professional experiences with remote monitoring in axSpA