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Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient's blood or body tissues to manage and optimize therapy. TDM is crucial for drugs with narrow therapeutic windows, like warfarin and phenytoin, where incorrect doses can lead to treatment failure or severe side effects. This monitoring ensures the dosage administered is within a safe and effective range. The factors affecting therapeutic drug monitoring include:Patient-Specific Factors:a.
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Tailoring Rheumatoid Arthritis Visit Timing Based on mHealth App Data: Mixed Methods Assessment of Implementation and

Robert S Rudin1, Leah M Santacroce2, Ishani Ganguli3,4

  • 1RAND, 20 Park Plaza, Boston, MA, 02116, United States, 1 6173382059.

JMIR Formative Research
|April 21, 2025
PubMed
Summary
This summary is machine-generated.

A mobile health app for rheumatoid arthritis (RA) patient-reported outcomes (PRO) showed good patient usage but did not reduce specialist visit frequency. Clinician engagement is key to using PRO data effectively for optimizing patient care.

Keywords:
mobile healthpatient-reported outcomesrheumatoid arthritisrheumatologyvisit frequencyvisit timing

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Area of Science:

  • Rheumatology
  • Digital Health
  • Health Services Research

Background:

  • Medical subspecialist visits are frequent, with follow-up timing often based on heuristics rather than evidence.
  • Unnecessary visits contribute to long wait times for new patients.
  • Systematic symptom monitoring using patient-reported outcomes (PRO) could optimize visit timing for conditions like rheumatoid arthritis (RA).

Purpose of the Study:

  • To explore reasons why a mobile health (mHealth) intervention using PRO data did not reduce RA patient visit frequency.
  • To assess app usage, usability, and identify barriers/facilitators for using between-visit PRO data to reduce specialist visits.

Main Methods:

  • Analyzed patient adherence (PRO completion) and retention (last month usage) for an mHealth app in 150 RA patients over 12 months.
  • Summarized rheumatologist use of an EHR-embedded PRO dashboard and system-generated visit timing messages.
  • Assessed usability via questionnaires and identified barriers/facilitators through patient/rheumatologist interviews and surveys.

Main Results:

  • Patients completed a median of 53.3% of PRO questionnaires; 56% used the app in the final month.
  • Rheumatologists viewed the PRO dashboard in 17.6% of visits, with significant variation between clinicians.
  • Barriers included clinician scheduling constraints and patient demotivation from lack of PRO data discussion.

Conclusions:

  • Frequent patient use of an mHealth app for RA PROs did not directly reduce specialist visit frequency.
  • Integrating between-visit PRO data into clinical practice requires improved clinician engagement.
  • Optimizing specialist visit timing necessitates addressing both technological and human factors in digital health interventions.