Hannah Labinsky1, Sophie von Rohr2, Maria Gabriella Raimondo3, Ekaterina Vogt4, Britta Horstmann2, Isabel Gehring5, Jessica Rojas-Restrepo5, Fabian Proft6, Felix Mühlensiepen7, Daniela Bohr2, Georg Schett8, Andreas Ramming3 and Johannes Knitza3, 1Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany, 2Department of Internal Medicine 3, Rheumatology & Immunology, Friedrich-Alexander-University (FAU) Erlangen-Nurnberg and University Hospital Erlangen, Erlangen, Germany, 3Department of Internal Medicine 3 – Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; Deutsches Zentrum Immuntherapie, Friedrich-Alexander-UniversityErlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany, 4Thermo Fisher Scientific, Freiburg, Germany, 5Thermo Fisher Scientific, Freiburg, 6Department of Gastroenterology, Infectious Diseases and Rheumatology, Charité – Universitätsmedizin Berlin, Berlin, Germany, 7Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, 8Universitätsklinikum Erlangen, Erlangen, Germany
Background/Purpose: The growing shortage of rheumatologists threatens adequate rheumatological care. The diagnostic delay for axial spondyloarthritis (axSpA) is particularly long, ranging between 3 to 11 years. Telemedical solutions seem promising to overcome current limitations. Additionally, health professionals (HP) could be integrated in routine care to increase available rheumatological workforce, enable pre-appointment preparation and accelerate therapy start. The objective of this study was to explore a new diagnostic pathway for patients with suspected axSpA (Fig. 1).
Methods: 20 patients with chronic back pain for more than 3 months were seen by an HP (T-1) prior to their actual rheumatologist visit (gold-standard) (T0). The HP (MD student) independently conducted the history, physical examination, blood collection and review of rheumatological reports. Findings were discussed with a rheumatologist to finalize diagnostics and initiate therapy. Patients completed two symptom checkers (SC), started to continuously report ePROs (BASDAI) via an app and received upper-arm self-sampling devices to self-collect capillary blood at home remote for C-reactive protein (CRP) and HLA-B27. Two additional rheumatologists reviewed SC, laboratory and imaging results to investigate an asynchronous telemedical diagnostic approach. The net promoter score (NPS), percentage of promoters (9-10) subtracted by percentage of detractors (0-6), was used to investigate patient acceptance.
Results: The diagnostic delay (T-1, T0) was significantly reduced by more than 2 months (Med±IQR, 29±30 days, 100.5±41 days, p< 0.0001). AxSpA was confirmed in 12 and neglected in 8 cases at T0. The diagnostic accuracy (axSpA yes or no) of the two SC (Ada and Bechterew-check) and the HP was 60%, 35% and 85%, respectively. The two rheumatologists reached an accuracy of 90% (interrater agreement of 100%). At-home self-collection was successfully conducted by 80%. Patients expressed high acceptance regarding the pre-appointment student visit, self-sampling and ePRO, with NPS of +75%, +20%, +10%, respectively.
Conclusion: To our knowledge this is the first study exploring the potential of self-sampling, HPs and asynchronous assessments to accelerate axSpA diagnosis. Our interim results show that the investigated modules are well accepted among patients and significantly reduced current axSpA diagnostic delay. Fig. 1. Investigated diagnostic pathway for patients with suspected axSpA SC, symptom checker; ePRO, electronic patient reported outcome; * in discussion with a rheumatologist to plan further diagnostics and start therapy Created with Biorender.com Disclosures: H. Labinsky, None; S. von Rohr, None; M. Raimondo, None; E. Vogt, Thermo Fisher Scientific; B. Horstmann, None; I. Gehring, Thermo Fisher Scientific; J. Rojas-Restrepo, Thermo Fisher Scientific; F. Proft, AbbVie/Abbott, Amgen, Bristol-Myers Squibb(BMS), Celgene, Eli Lilly, Janssen, Merck/MSD, Novartis, Pfizer, Roche, UCB; F. Mühlensiepen, Novartis, AbbVie/Abbott; D. Bohr, None; G. Schett, None; A. Ramming, Boehringer-Ingelheim, Janssen, Gilead, Novartis, Pfizer; J. Knitza, AbbVie, Novartis, ThermoFisher, UCB, ABATON, Sanofi, Medac, Lilly, BMS, Gilead, GSK, Werfen, Vila Health, Böhringer Ingelheim, Janssen, Galapagos, Chugai.
Fig. 1. Investigated diagnostic pathway for patients with suspected axSpA