0537: Asynchronous Teleconsultation by WhatsApp Chatbot in Controlled Axial Spondyloartrhitis Patients Under Biological Therapy as a More Sustainable Model Than Face-to-face Classical Consultation
Natalia Rivera1, elena abad plou2, Eva Galindez-Agirregoikoa3, Eduardo Cuende4, Ana Rosa Intxaurbe5, Juan M Blanco Madrigal3, Lucia Vega-Alvarez3, Carmen Lucia Garcia-Gomez6, Maria Enjuanes-Noguero7, Olaia Fernandez-Berrizbeitia8, Maria Rosa Exposito Molinero9, Maria Esther Ruiz Lucea3, Ignacio Torre Salaberri5, iñigo Gorostiza Hormaeche3 and Maria Luz Garcia Vivar3, 1Biocruces Bizkaia Health Research Institute, Research area, Bilbao, Spain, 2Hospital universitario de Basurto, Bilbo, Spain, 3Basurto University Hospital, Bilbao, Spain, 4Basurto University Hospital, Rheumatology, Madrid, Spain, 5Basurto University Hospital, Rheumatology, Bilbao, Spain, 6Basurto University Hospital, Rheumatology, Terrassa, Spain, 7Hospital Universitario de Basurto, Bilbao, Spain, 8Spanish Health Care Service, Bilbao, Spain, 9Hospital de Basurto, Bilbao, Spain
Background/Purpose: Before COVID pandemic, telehealth use for the followup of rheumatic disease patients had been limited, but nowadays it appears as a more sustainable model of consultation, as it seems to be time and resources sparing for the patiens and the healthcare system.
Prove that the use of asynchronous telehealth followup with whatsapp platform chatbot among our controlled AS patients under biological therapy, was less time (and resource) consuming for the patient and the system.
Methods: A prospective study with retrospective control was performed, choosing AxSPA patients under biological therapy with stable disease, visited in our centre from 01/01 to 30/11/2021. We recruited 62 patients, but 2 quit for home moving or personal reasons. We offered them 2 teleconsultation visits (using their personal mobile), every 4 months, and a presential final visit one year after inclusion. The chatbot sends PROMS (BASDAI, VAS for patient global disease assessment, ASDAS, and 3 questions for extraarticular disease), and feedback and schedule for the following visits. In case of lab test or PROMs deviation or when the patient asks for contact, it is phoned by nurse/doctor who solves the question and/or arranges an additional presential visit. We collect patient and disease characteristics (age, gender, educational level, employment, disease activity, duration and treatments), patients preferences, and number of presential visits and phone calls from the year previous to inclusion.
Results: We included 60 patients ( 83,3% men), mean aged 48,22 years (SD 12,128), 36% under 45 years at inclusion. 83.3% were active working and only 10 patients were jobless or retired. They were Ankylosing Spondylitis (AS) (90%), HLA B27 positive (85%) with longstanding disease (mean 23 years, SD 12,8), and were receiving the first (71%), or the second (23%) biological therapy (51,7% tapered anti-TNF). 25% presented peripheral impairment, and over 40% extraarticular manifestations.
At inclusion 93,3% were at remission/LDA by ASDAS/BASDAI-RCP and 4 patients were considered clinically controlled in spite of higher scores. At followup 3 patients with reduced dose needed to increase to standard dose of biological drug, with no other need of treatment change. There was no worsening from basal to final visits according BASDAI, BASFI, ASDAS-RCP or AsQOL. Patients final VAS score (1-10) assesment of telehealth consultation was high: mean 9,14 (DS 1,498) and 83,3% preferred telehealth followup.
In this study we spared 62% presential visits (Only needed 70, 60 scheduled and 12 additional). Patients estimated time needed for presential consultation was 90 +/- 30 minutes including approach to hospital and waiting times. For the healthcare team, time needed for whatsapp consultation was 1/3 from the needed for presential consultation.
Conclusion: Asynchronous telehealth followup with whatsapp platform chatbot in our controlled AxSPA patients under biological therapy resulted time sparing for the patient and the system, as it reduces time in presential consultation. The use of this model of telehealth approach in an enviroment different from a clinical study is needed for more precise saving estimates.
N. Rivera: None; e. abad plou: None; E. Galindez-Agirregoikoa: None; E. Cuende: None; A. Intxaurbe: None; J. Blanco Madrigal: None; L. Vega-Alvarez: None; C. Garcia-Gomez: None; M. Enjuanes-Noguero: None; O. Fernandez-Berrizbeitia: None; M. Exposito Molinero: None; M. Ruiz Lucea: None; I. Torre Salaberri: None; i. Gorostiza Hormaeche: None; M. Garcia Vivar: None.
