IARPlus App

Towards multi-channel models. An innovative model for taking care of patients with rheumatoid arthritis.

Principal investigator: Valeria D. Tozzi (CeRGAS)

Team UB/Cergas: Lucia Ferrara, Elisabetta Listorti

Partners: UOC Reumatologia – ASST Niguarda, Milano

Sponsor: Galapagos Biopharma Italy S.r.l.

Duration: May 2021-January 2022

Abstract:

Over the past few decades, there has been an increasing debate surrounding the use of telehealth. However, there is still a slow rate of adoption of telehealth services. According to a recent scoping review, this may be due to a piecemeal approach to the change process and a lack of understanding of how to plan, manage, and reinforce change when implementing telehealth services. A noteworthy example of the implementation of telehealth services can be found within the rheumatology unit of Niguarda Hospital in Milan, Italy, where the entire staff has been experimenting with new multichannel interactions to communicate with patients for over a decade. Initiated in 2011 with the introduction of the iAr Plus app for the collection of Patient Reported Outcomes (PROs), the project was initially targeted at patients with Rheumatoid arthritis, Psoriatic arthritis, and Spondylarthritis. In 2019, the project expanded to include home delivery of biological drugs for stable patients. In the spring of 2020, this experience was further enhanced and extended to all patients treated with biological drugs to facilitate patient interaction during Covid-19. This approach was characterized by three elements: remote monitoring, triage through phone calls, and home delivery of medication.

The project had two primary objectives: first, to highlight the distinctive and successful elements of this implementation experience, extract lessons from it, and derive managerial implications for future implementations. Second, considering that the final decision to adopt telemedicine rests with patients, the perspective of the patients was considered, focusing on three main aspects: i) the perceived benefits, ii) the willingness to enroll in future projects, and iii) the preference for the service mix, i.e., remote contacts rather than in-person visits.

We adopted a mixed-method approach. To address the first objective, we used a realist evaluation approach to identify the underlying generative mechanisms explaining 'how' the outcomes were achieved and the influence of context. We delved into how the change management process was handled by conducting semi-structured interviews with the unit director and the staff members involved in the project phases (i.e., clinicians, nurses, and administrative staff). For the second objective, we conducted a survey from November 2021 to January 2022, randomly enrolling outpatients who visited the rheumatology unit for any reason, including both telehealth users and non-users. A complete response was provided by 400 patients.

Our study contributes to shedding light on the crucial role played by the telehealth experience in determining patients' preferences. On one side, users appeared more aware of the realistic benefits to be expected from telemedicine. On the other side, it seemed that the more telehealth was experienced, the higher the willingness to adhere to future projects and to increase on-distance contacts.

Second, our study contributes to identifying which strategic and operational practices are essential during the phases of preparing for change, managing change, and reinforcing change. The study unveiled several key findings: a conducive context and a robust managerial structure were prerequisites for success. Clear leadership, specialized roles, team involvement, and regular communication were essential generative mechanisms. Involving end-users in defining the care pathway was pivotal, with patients making the final decisions on service usage. Engaging relevant stakeholders from the app's co-design phase was also critical. Lastly, adopting an incremental approach to change, introducing one change at a time, led to continuous improvement. The findings provide valuable insights into telehealth implementation. The framework (Kho, 2020) used can serve as a tool for retrospective analysis of past experiences and as a guide for future implementations and research. The lessons learned can inform the implementation of future telehealth initiatives, ultimately advancing the field of telehealth and enhancing healthcare delivery.

Material produced and publications:

Listorti, E., Ferrara, L., Adinolfi, A. et al. (2023). Joining telehealth in rheumatology: a survey on the role played by personalized experience from patients’ perspective. BMC Health Serv Res 23, 682 (2023).

Ferrara L, Listorti E, Adinolfi A, et al (2022). POS1553-HPR A virtuous implementation of telemedicine services in rheumatology: description of change management practices adopted by the Niguarda hospital. Annals of the Rheumatic Diseases 2022;81:1121.

Listorti, E., Ferrara, L., Adinolfi, A., Gerardi, M. C., Ughi, N., Tozzi, V., & Epis, O. M. (2022). POS1543-HPR Joining Telemedicine Services in Rheumatology: the Role Played by Personalized Experience From Patients’ Perspective. Annals of the Rheumatic Diseases 2022;81:1116.

Presentations:

Listorti E., Ferrara L., Adinolfi A, Gerardi MC, Ughi N, Epis O.M., Tozzi V.D. (2022). Partecipare a progetti di telemedicina in un reparto di reumatologia: il punto di vista dei pazienti sul ruolo svolto dall'esperienza personalizzata, Conferenza AIES – 8-9 September 2022, Messina

Ferrara L., Listorti E., Adinolfi A, Gerardi MC, Ughi N, Epis O.M., Tozzi V.D. (2022). How to implement telemedicine services? Lessons learned from the experience of the rheumatology unit of Niguarda Hospital, Conferenza AIES – 8-9 September 2022, Messina.

Ferrara L., Listorti E. (2022), A virtuous implementation of telemedicine in rheumatology: description of change management practices and analysis of the role played by personalized experience in the patients’ answer, Cergas Seminar – 20/01/2022