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Background: During the COVID-19 pandemic, we had to change our care practices, and remote consultation became a valuable tool for patient follow-up. We designed a Hybrid follow-up, alternating in-person visits with remote consultations supported by an electronic health record [EHR]-integrated platform, to take care of RA patients, and we compared 6-month outcomes of a hybrid strategy versus standard in-person care.
Objectives: To compare 6-month patient-reported functional outcomes and disease activity between a hybrid follow-up strategy and standard in-person care in adults with rheumatoid arthritis.
Methods: This is a cross-sectional study of the RA adult cohort comparing two follow-up strategies in a single centre. Patients were randomly assigned to Hybrid follow-up or Standard of care (SOC; in-person visits only). We conducted a 6-month follow-up, collecting RAPID3, DAS28, HAQ Disability Index (HAQ-DI), and SF-36 domains, and compared changes from baseline.
Results: 221 patients were included; mean age was 52 years (SD 12); 76% female. Rheumatoid factor 72/81 (88.9%) in the SOC group and 133/140 (95.0%) in the Hybrid group (p=0.10). Anti-CCP positive was 65/81 (80.2%) in the SOC group and 111/140 (79.3%) in the Hybrid group (p=1.00). 140 have a Hybrid follow-up, and 81 were in the SOC group. Paired data were available for RAPID3 (Hybrid, n=72; SOC, n=46), DAS28 (77; 57), and HAQ-DI (132; 73). RAPID3 improved in both groups: median (IQR) 15.8 (9.9-19.7) to 10.1 (5.2-12.8) in Hybrid and 12.1 (8.1-16.0) to 9.2 (4.6-13.3) in SOC. Median change was -4.5 (-11.1 to 0.1) versus -1.9 (-6.9 to 2.9), respectively (p=0.097). DAS28 decreased modestly and similarly: 3.52 (2.59-4.38) to 3.29 (2.37-4.31) in Hybrid and 3.53 (2.80-4.66) to 3.34 (2.77-4.24) in SOC (between-group p=0.95). HAQ-DI was stable: 1.10 (0.50-1.50) to 0.88 (0.38-1.41) in Hybrid and 0.90 (0.50-1.30) to 0.88 (0.50-1.50) in SOC (between-group p=0.16). SF-36 improved in several domains: Pain 58 (34-74) to 68 (45-95) in Hybrid vs 58 (45-70) to 70 (45-100) in SOC (p=0.96), and Vitality 50 (40-67.5) to 50 (40-70) vs 50 (40-60) to 60 (50-80) (p=0.20). No SF-36 domain showed a significant between-group difference in change (all p>0.05).
Conclusions: In our cohort, a hybrid follow-up strategy yielded 6-month patient-reported functional and disease activity outcomes comparable to those of standard in-person care, suggesting it is a practical option for routine follow-up. This study demonstrates that a hybrid follow-up approach may be effective for patients with RA. These results should be validated in external cohorts and with longer follow-up, ideally including more complex endpoints, such as radiographic progression, to strengthen the robustness of these findings.
Baseline characteristics of the study population
| In-person follow-up (SOC) (n=81) | Hybrid follow-up (n=140) | p value | |
|---|---|---|---|
| Age, years | 54.00 (45.00–60.00) | 50.00 (43.00–60.00) | 0.208 |
| Female sex, n (%) | 61/81 (75.3%) | 108/140 (77.1%) | 0.745 |
| Rheumatoid factor (latex) positive, n (%) | 72/81 (88.9%) | 133/140 (95.0%) | 0.109 |
| Anti-CCP positive, n (%) | 65/81 (80.2%) | 111/140 (79.3%) | 1.000 |
| ESR baseline (mm/h) | 11.00 (6.00–20.00) | 13.50 (7.00–22.00) | 0.236 |
| CRP baseline (mg/L) | 3.28 (1.50–10.00) | 2.50 (0.86–7.00) | 0.166 |
| DAS28 baseline | 3.53 (2.79–4.65) | 3.44 (2.59–4.38) | 0.679 |
| HAQ-DI baseline | 0.90 (0.50–1.30) | 1.10 (0.50–1.50) | 0.169 |
| RAPID3 baseline | 12.20 (8.70–16.20) | 14.85 (9.62–19.00) | 0.044 |
REFERENCES: NIL.
Acknowledgments: NIL.
Disclosure of Interests: None declared.