Attitudes to technology supported rheumatoid arthritis care: investigating patient and clinician perceived opportunities and barriers

Abstract Objectives Globally, demand outstrips capacity in rheumatology services, making Mobile Health (mHealth) attractive, with the potential to improve access, empower patient self-management and save costs. Existing mHealth interventions have poor uptake by end-users. This study was designed to understand existing challenges, and opportunities and barriers for computer technology in the rheumatoid arthritis (RA) care pathway. Methods People with RA were recruited from Barts Health NHS-Trust rheumatology clinics to complete paper questionnaires, and clinicians recruited from a variety of centres in the UK to complete an online questionnaire. Data collected included: demographics; durrent technology use; challenges managing RA; RA medications and monitoring; clinic appointments; opportunities for technology, and barriers to technology. Results : 109 patient and 41 clinician questionnaires were completed. 83.5% patients and 93.5% clinicians used smartphones daily. However only 25% had ever used an arthritis app and only 5% had persisted with one. Both groups identified managing pain, flares and RA medications as areas of existing need. Access to care, medication support and disease education were mutually agreeable opportunities; however, discrepancies existed between groups with clinicians prioritising education over access, likely due to concerns of data overwhelm (80.6% considered this a barrier). Conclusion In spite of high technology usage and willing from both sides, our cohort did not utilise technology to support care, suggesting inadequacies in existing software. Lack of an objective biomarker for RA disease activity; existing challenges in the healthcare system and need for integration with existing technical systems were identified as the greatest barriers. Trial registration Registered on CRN registry (IRAS ID—264690) Lay Summary What does this mean for patients? Globally, demand outstrips capacity in rheumatology services, making Mobile Health (mHealth) attractive; however, existing mHealth interventions have poor uptake. This questionnaire study forms part of a mixed methods study aiming to understand the real needs of people with rheumatoid arthritis (RA), as well as those of their clinicians, to ensure future technology provides solutions to the challenges for those living with RA. 109 patients and 41 clinicians completed questionnaires. Whilst the vast majority used smartphones daily, only 25% had ever used an arthritis app, and only 5% had persisted with one. Both groups identified managing pain, flares and RA medications as areas of existing need. Access to care, medication support and disease education were agreed opportunities. Differences existed between groups with clinicians prioritising education over access, due to concerns about managing the large volumes of patient data submitted. In spite of high technology usage and willingness from both sides, our cohort did not use technology to support care, suggesting inadequacies in existing software. Lack of a reliable marker for RA disease activity, existing challenges in the healthcare system and need for integration with existing technical systems were identified as the greatest barriers.