Patients with RA View Text Message Platform as Supportive Tool for Care

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Patients with rheumatoid arthritis (RA) viewed the text message-based WelTel platform as a supportive tool for delivering high-quality care, according to a study published in ACR Open Rheumatology.¹ Although these results are promising, the impact of the increased workload and communications on clinician burnout should be considered. Top of Form

WelTel was initially developed over a decade ago to help patients living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDs) in Africa and has been shown to support the management of a variety of conditions since then. Previous research has indicated the secure platform helps to improve patient health outcomes and clinic efficiencies in several care models. However, it has not been tested for patients with rheumatic conditions.²

“Rheumatoid arthritis (RA) is a chronic disease that causes joint pain and inflammation and is managed using a treat-to-target (T2T) strategy,” wrote a team of investigators led by Saania N Zafar, MSc, associated with the University of Calgary in Alberta, Canada, and Arthritis Research Canada, in British Columbia, Canada. “However, employing this strategy can be difficult as follow-up appointments are booked at fixed intervals, requiring rheumatologists to make assumptions about patient response to therapy or disease activity. Due to the dynamic nature of RA, patients may need to be seen earlier than their scheduled appointment or receive care between appointments. Novel methods of delivering care, such as virtual care, have been proposed to optimally support patient needs.”

To understand the perspectives and experiences of both patients and heath care providers, investigators invited 70 patients with RA to participate in the 6-month WelTel pilot program, in addition to routine care. Each month, patients received “How are you?” text message check-ins, in which patients could then message their health care team during clinic hours to ask for health advice.

A subgroup of patients (n = 13, 62% female, mean age 62 years, 10 White) participated in a post-program interview. A deductive approach was used to create a thematic analysis of the transcripts.

Patients perceived WelTel as a beneficial tool for providing quality care across domains including safety, efficacy, efficiency, equity, timeliness, patient-centeredness, and appropriateness. These patients said the platform allowed them to feel heard and supported, they received quick responses, and it allowed for faster access to care when compared with usual care. They noted the comfortability with text messaging, the conversational aspect, and the ability to reply when convenient as additional benefits.

However, perspectives varied among the 7 clinicians (6 rheumatologists, 1 pharmacist, 57.1% female) who participated in an interview. While some believed this platform has the potential to increase efficacy and improve patient-centered care, others thought it could increase their current work demands and cause burnout. Interestingly, patients believed this system could save their doctor’s time by potentially reducing the need for in-between appointments and allowing other qualified employees—such as nurses—to answer their questions.

Investigators noted the lack of diversity among subjects who agreed to be interviewed, which could indicate additional barriers to participation. Additionally, future research should include perspectives from registered nurses, as they have led the implementation of WelTel in previous research. There is a potential for recall bias due to relying on patients to remember information from during the program; however, investigators minimized this chance by scheduling the interviews directly after the study period.

“This study provides a foundational understanding of the perspectives and experiences of patients and health care providers regarding the use of text messaging to support care for patients with RA,” investigators concluded. “Currently, accessing care and health advice when needed through telephoning the clinic is difficult for many patients. Text messaging enhanced patients’ abilities to access high-quality patient-centered care.”

References

1. ^{Zafar SN, Hazlewood G, Dhiman K, et al. "How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis. ACR Open Rheumatol. Published online February 20, 2024. doi:10.1002/acr2.11652}
2. ^{Mary A, Boursier A, Desailly Henry I, et al. Mobile phone text messages and effect on treatment adherence in patients taking methotrexate for rheumatoid arthritis: a randomized pilot study. Arthritis Care Res (Hoboken) 2019; 71(10): 1344–1352.}