Experiences with patient-initiated follow-up supported by asynchronous telemedicine in spondyloarthritis: a mixed methods study

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OBJECTIVES: To evaluate the experiences of patients with spondyloarthritis (SpA) and their healthcare providers (HCPs) with patient-initiated follow-up (PIFU) supported by asynchronous telemedicine (TM) compared with their past experiences with usual care, and to identify prerequisites for sustainable implementation of PIFU/TM. METHODS: Individual, semi-structured interviews were conducted with purposefully selected patients (n = 21) and HCPs (n = 9) who previously participated in the 'TeleSpA' randomised controlled trial and thematically analysed. PIFU/TM consisted of a once-yearly pre-planned physical visit with in-between remote monitoring at 6 months. Additionally, 13 HCPs completed a quantitative survey, which was analysed descriptively. RESULTS: Most patients and HCPs found PIFU/TM acceptable, given the presence of sufficient health literacy, digital literacy and motivation. Most patients felt no burdensome changes to their personal responsibility, and both in-person and remote communication between stakeholders ran smoothly. Advantages for patients included time savings, and improvements in disease insight and self-efficacy. Some HCPs experienced increased flexibility in their daily planning. Pivotal prerequisites for sustainable implementation were adequate infrastructure to conduct ad hoc diagnostic tests, assured rapid access to the outpatient clinic when necessary, availability of technical and logistical support, and a user-friendly monitoring tool integrated with existing hospital information systems. Fine-tuning the design and delivery of questionnaires as part of TM is an opportunity for future research. CONCLUSION: PIFU/TM was perceived as an acceptable approach for the follow-up of motivated patients with SpA with adequate health literacy and digital literacy. Preserved accessibility to the outpatient clinic and availability of ancillary support are essential for its sustainable implementation.

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