Many patients can be followed up with fewer check-ups
A new study shows that both digital home monitoring and patient-directed monitoring can save healthcare resources, without compromising patient safety or satisfaction. It could provide more flexible and efficient healthcare services for patients with chronic diseases.
Professor Nina Østerås led the randomized, controlled trial at Diakonhjemmet Hospital. Many patients with chronic illnesses are regularly referred to specialist health services for follow-up. Østerås explains that digital home monitoring and patient-directed follow-up are increasingly being used in health services.
This is the first study to systematically examine how a digital and patient-driven model works for patients and healthcare professionals.
“Many are introducing new, digital follow-up models without first investigating their effects. We wanted to find out whether two new follow-up models were equally good at controlling the disease compared to patients being regularly called in for appointments at the hospital, guided by a calendar,” explains Østerås.
The study has now been published in the renowned journal, Annals of The Rheumatic Diseases, https://ard.eular.org/article/S0003-4967(25)00908-2/fulltext
New models of follow-up were equally good for patients
A total of 243 patients with the rheumatic disease axial spondyloarthritis participated in the study between 2021 and 2023. The vast majority were employed and the disease was in a quiescent phase when the study began. The patients were randomly assigned to receive follow-up either digitally, according to their own needs, or through regular, regular check-ups.
– After 18 months, the results were similar in all three groups when it came to treatment effect and patient safety, says Østerås.
Increased flexibility and saved resources
In the group with digital home follow-up, the need for follow-up was assessed based on the patients' monthly reporting of complaints from the disease, via an app. If the reports indicated increased disease activity, the nurse contacted them for further assessment.
Patients in the patient-directed follow-up group did not have regular check-ups, but were asked to contact a nurse if their illness worsened. They were offered an immediate doctor's appointment if they wished.
The group with traditional, regular follow-up received an appointment, with attendance at the hospital, every six months.
Patients with patient-directed follow-up had the least follow-up from healthcare professionals in the study. That is, they had little need for check-ups and had the fewest telephone calls with healthcare professionals.
The group with digital home monitoring also had little need for check-ups, compared to those with regular check-ups. There were most short phone calls in the digital group, as health professionals contacted patients based on their own reports in the app.
Nina Østerås says that the study showed that new strategies for follow-up can save patients time and resources. It can also free up time for healthcare professionals to spend on other patients. The new models can therefore be good alternatives for following up people with chronic illness.
She emphasizes that digital home monitoring will require changes in how healthcare professionals work. Stable and user-friendly technology is also important for making digital monitoring work. “In addition, there should be financial incentives so that hospitals prioritize investing in software to be able to offer digital home monitoring,” says Østerås.
Satisfied patients
Patients were satisfied with the follow-up they received, regardless of which of the three models they followed.
Researcher and consultant in rheumatology, Inger Jorid Berg, meets many of these patients in treatment at the hospital. “The study gave us important knowledge to be able to meet patients with more flexible, personalized and effective models for following up on their chronic disease,” she emphasizes.
The study also showed that many patients with axial spondyloarthritis can manage their own follow-up. “It is important to be organized so that patients can get an appointment as soon as possible if the disease worsens. This is already the case at our outpatient clinic at Diakonhjemmet Hospital,” says Dr. Berg.
Both digital and patient-directed follow-up work well when the disease is peaceful
Postdoctoral fellow Christine Hillestad Hestevik has conducted in-depth interviews with 18 of the patients who participated in the study.
– Patients reported that both models of follow-up were satisfactory when their disease condition was well controlled, she summarizes.
The interviews also revealed that patients were motivated to have less frequent follow-up due to limited resources in the healthcare system. They justified this with the desire to free up resources for other patients.
Patients also appreciated that the new models reduced the need to take time off work and allowed them to shift their focus away from their illness.
Some also appreciated the opportunity to take greater responsibility for their own follow-up.
– Some were also skeptical of the rapid advances in technology and preferred face-to-face meetings for emotional support and security in follow-up, says Hestvik.
The interviews also revealed that technical challenges and lack of trust in the technology were important barriers to digital home monitoring.
Patients were positive about digital home monitoring
Emil Eirik Kvernberg Thomassen was a doctoral fellow in the study. He investigated patients' attitudes towards regularly reporting digitally from home.
– Most patients were positive about testing digital home monitoring. They followed up well with the regular reporting from home, throughout the entire 18-month period, says Thomassen.
He adds that they saw a slight tendency for age, education level, health literacy, physical function, and employment status to influence how positive they were about trying digital home monitoring. However, these factors did not play a role in how well they followed up on reporting in the app.
Funding and further research
The study is funded by research funds from the South-Eastern Regional Health Authority (RHF) and the Research Council of Norway. The researchers will now link the results of the study to data from national registers on health service consumption for further health economic analyses.
Fact box:
ReMonit is a short version of the full name of the study: Remote monitoring of axial spondyloarthritis in specialist healthcare services
Axial spondyloarthritis is a chronic, rheumatic disease with inflammation of the pelvic joints and spine, which causes stiffness and pain in the lower back. Pain and stiffness are often relieved by physical activity. The disease can cause inflammation in other joints and tendons, as well as eye inflammation, intestinal disease and psoriasis. Axial spondyloarthritis occurs in early adulthood, most often before the age of 45. Some patients are treated with immunosuppressive drugs that effectively reduce pain and stiffness.
Read more about the ReMonit study here : https://remedy-senter.no/project/remonit?highlight=WyJyZW1vbml0Il0 =
Read the publications:
Link to the main study: https://ard.eular.org/article/S0003-4967(25)00908-2/fulltext
