POS1482-HPR ASYNCHRONOUS TELECONSULTATION BY WHATSAPP CHATBOT IN CONTROLLED AXIAL SPONDYLOARTHRITIS (SPA) PATIENTS UNDER BIOLOGICAL THERAPY: 10 MONTHS EXPERIENCE AT A SINGLE CENTRE

Abstract

Background: The use of telehealth in the control of rheumatic diseases had been scarce, but COVID pandemic forced rheumatologists to try alternatives to classic face-to-face consultation. In times of lockdown phone calls and video calls were easy to perform, but later on an asynchronous model of teleconsultation would probably ft better. The purpose of this study is to prove that asynchronous whatsapp teleconsul-tation is an effective alternative to classic healthcare consultation models out of pandemic. So, we selected axial spondyloarthritis (SPA) patients with stable controlled disease under biological therapy and we offered teleconsultation with a whatsapp platform chatbot, that's been created for this purpose as a way to send PROMS (BASDAI, VAS for patient global disease assesment, ASDAS, and 3 questions for extraarticular disease), and receive feedback and schedule for the following visits Objectives: To prove that teleconsultation through whatsapp platform was not inferior to face-to-face consultation in terms of mantaining axial SPA patients disease under control. And to prove that teleconsultation model was less time and resources consuming for the patient and the system, and probably preferred by a group of patients. Method(s): Prospective study with retrospective control of patients diagnosed of Axial SPA, fullflling ASAS criteria and with stable disease under biological therapy for the previous year, recruited from 01 jan to 30 nov 2021. We offered them two teleconsultation visits using their personal mobile device, once every four months and a face-to-face visit at the end of the study (one year since inclusion). If there is a deviation in the lab test or PROMs or if the patient asks for contact (via whatsapp) he is called up by the person in charge (nurse/doctor) that solves the question and arranges an aditional presential visit when needed. We consider disease controlled if BASDAI <4, ASDAS < 2,1 or if in rheumatologist's opinion there is no need to change treatment. We collect patient and disease information (age, gender, employment, use of mobile devices, duration and characteristics of the disease, previous and actual treatment), activity (BASDAI, PCR, ASDAS), physical function (BASFI), Quality of life (AsQol) ansd productivity (WAPAI), and we also check number of face-to-face and phone consultations and patient's preferences. Result(s): 62 patients (52 men and 10 women) were recruited, mean aged 47,7 years (range 26-72), 36% were under 45 years at the time of inclusion. They were mostly Ankylosing Spondylitis (AS) (90%; only 6 non radiographic SPA), positive HLA B27 (90%) and with longstading disease (mean 24 years), and only 6 patients less than five years. 16% had peripheral involvement (arthri-tis/dactylitis), and 40% presented extraarticular manifestations, mainly uveitis (20%). 70% were under their frst biological (TNF inhbitor, mostly adalimumab), 24% were refractory to the frst, 3 patients to 2 previous biologicals and just 1 patient was refractoy to 5. 50% of patients were treated with tapered dose of TNF inhibitors. We have now a mean followup of 10 months, in which we have had 109 scheduled teleconsultations with aditional need of 36 phone calls and 10 aditional presential visits for the whole group. To date, 3 patients with reduced dose increased to standard dose of biological drug and none change of biological was required. Conclusion(s): Asynchronous teleconsultation seems promising, specially for followup in patients with stable rheumatic disease, less interfering with daily activities, less time consuming for the patient and less resource consuming for healthcare systems, with no impairment of disease control and quailty of healthcare. This study will also show patient's preference, and well try to describe a profile of patient more prone to teleconsultation.