Discussion
RA, rheumatic, ’
DISEASE
In this qualitative study, we explored RA patients’ and physicians’ experiences using a new ePRO web app ABATON RA, including drawbacks, as well as benefits of app-supported rheumatology care. Overall, the results demonstrate the feasibility of digitally supported SDM and T2T, ease of use of the app and the overall dominance of observed benefits.Users appreciated having a better overview of disease activity. Some RA patients perceived the app as supportive for their care, i.e., making disease flares but also disease improvement visible, graphically and in numbers. Similarly, physicians felt better prepared for the appointment and treatment decisions. Compared to traditional paper-based PRO, users reported the potential of time-saving and paper reduction. The high level of repetition and standardization, as well as potentially inaccurate data and difficult-to-understand PRO questions were reported as limitations. Physicians feared to become too focused on ePRO data, stressed the lack of reimbursement and interoperability. Participants stressed that some patients might be left out due to a lack of technical skills and equipment.Collection and graphical display of disease activity has been previously identified as a main app function, desired by rheumatic patients and can support care in multiple ways [This study has some limitations. First, all patients were recruited in a single study site, thus results might not be generalizable. Second, even though all of the physicians interviewed were practicing in rheumatology care, only one physician was a finished-trained rheumatologist; the other four physicians were completing their residency training in rheumatology. Furthermore, participating physicians did not have access to any preliminary results of the AORTA trial and did only describe their individual study experiences. The choice of ePRO and reasons for it were not discussed. Recall bias cannot be excluded, e.g., due to time difference between app use and the interview. In addition, results may be biased toward the benefits as participants agreed to participate in the study in the first hand. A major strength of this study is the open and explorative study design and the diversity of the included patients (age, sex, education and occupation).