Digital Health Applications: Toward a Lifecycle and Pay-for-Performance Approach

Real-World-Evidence of Digital Health Applications (DiGAs) in Rheumatology: Insights from the DiGAReal Registry

INTRODUCTION

Prescribable digital health applications (DiGAs) present scalable solutions to improve patient self-management in rheumatology, however real-world evidence is scarce. Therefore, we aimed to assess the effectiveness, usage, and usability of DiGAs prescribed by rheumatologists, as well as patient satisfaction.

METHODS

The DiGAReal registry includes adult patients with rheumatic conditions who received a DiGA prescription. Data at baseline (T0) and the 3-month follow-up (T1) were collected through electronic questionnaires. Study outcomes included DiGA-specific outcome assessments as well as generic outcome assessments, including the Patient Global Impression of Change (PGIC), Patient Activation Measure (PAM®), and the German Telehealth Usability and Utility Short Questionnaire (TUUSQ). Changes between T0 and T1 were analyzed using descriptive statistics and paired tests.

RESULTS

A total of 191 patients were included between June 2022 and April 2023. Of these, 127 completed the 3-month follow-up, and 114 reported using the prescribed DiGA, with 66% reporting weekly use and 15% completing the full DiGA program. The most commonly prescribed DiGAs targeted pain management (53%). Symptom improvement was reported by 51% of patients using a DiGA, with significant reductions in exhaustion levels (p = 0.03). Significant DiGA-specific improvements were observed for DiGAs addressing back pain (p = 0.05) and insomnia (p = 0.006). However, no overall significant changes were detected in patient activation, health literacy, pain, overall health, or disease activity. Back pain and weight management DiGAs were the most effective, frequently used, and best-rated DiGAs, with symptom improvements reported by 50% to 82% of patients.

CONCLUSION

The findings suggest that DiGAs can improve symptom management in rheumatic patients, especially for conditions like back pain and weight control. Further real-world evidence is needed and may support value-based digital health efforts and reimbursement frameworks.

Back on track - digital health applications to treat back pain of rheumatic patients? Results of a qualitative interview study

Non-specific low back pain (NLBP) is prevalent among patients with rheumatic conditions. Digital health applications (DiGAs) provide reimbursed, personalized home treatment for patients, promising to overcome limitations of traditional healthcare systems. However, the adoption and effectiveness of back pain-specific DiGAs in rheumatology are not well understood. This study aims to explore the experiences and perspectives of a diverse group of rheumatology stakeholders regarding the use of DiGAs for back pain management. Qualitative interviews and a focus group discussion were conducted with a wide range of stakeholders including rheumatic patients, rheumatologists, nurses and DiGA producers. The data were analysed using qualitative content analysis. The study included 15 interviews (10 rheumatic patients, 4 rheumatologists, 1 DiGA producer) and 1 focus group with mixed participants (n = 12). Most stakeholders valued the instant access to personalized and effective back pain treatment provided by DiGAs. Patients appreciated the flexibility and ease of use of DiGAs which can be used anywhere and anytime. Concerns were raised about insufficient guidance regarding correct execution of exercises, which was seen as potentially dangerous and unsettling for patients. Healthcare professionals (HCPs) highlighted barriers, such as the lack of reimbursement, time constraints, and inadequate DiGA-specific education as barriers to prescribing DiGAs. Additionally, poor patient onboarding often led to delays, increased skepticism, and premature discontinuation of therapy. Stakeholders emphasized the challenges of current care driven by a shortage of HCPs and generally supported usage of back pain DiGAs. Various barriers and solution approaches were identified to enhance the performance, usability, and implementation of DiGAs in rheumatology.

[Digital health applications-What we should know as rheumatologists]

Digital health applications (DHAs) are revolutionising patient care by improving access to evidence-based therapy and promoting active self-management. The continuously growing number of DHAs enables patients to act more independently through digital support. The budget-neutral prescription and cost coverage by statutory health insurance companies reduce financial barriers for practitioners and patients. Initial studies show that DHAs can be used successfully to treat comorbidities and rheumatic diseases. Several DHAs for inflammatory rheumatic diseases are at an advanced stage of development. The identification of suitable patients and support through shared decision making are crucial for successful implementation. Challenges remain in adherence and acceptance of the applications. This article provides an overview of prescription in clinical routine, initial data and experiences from the reality of rheumatology care, and reports on current developments.

Rheumatology in the digital health era: status quo and quo vadis?

Rheumatology faces a critical shortage of health-care professionals, exacerbated by an ageing patient population and escalating costs, resulting in widening gaps in care. Exponential advances in digital health technologies (DHTs) in the past 5 years offer new opportunities to address these challenges and could contribute to overall improved health care. However, keeping pace with innovations and integrating them into clinical practice can be challenging. This Review explores the transformative potential of DHTs for rheumatology in reshaping the entire patient pathway and redefining the roles of patients and providers, and discusses the potential barriers to DHT integration. Key technologies, such as large language models, clinical decision-support systems, digital therapeutics, electronic patient-reported outcomes, digital biomarkers, robots, self-sampling devices and artificial intelligence-based scribes, can be implemented along the patient pathway. A digital-first hybrid stepped-care patient pathway could combine in-person and remote care, enabling personalized and continuous monitoring through a digital safety net. The potential benefits and risks of transforming the traditional patient-provider relationship into a digital health triad with technology are discussed. Collaborative efforts are needed to navigate the evolving digital health landscape and harness the potential of DHTs to improve rheumatology care.