SQUEEZE WP#8: Development, implementation and pilot testing of an innovative eHealth powered integrated care model for rheumatoid arthritis

Background

Rheumatoid arthritis (RA) is a chronic, immune-mediated and potentially disabling disease affecting approximately 5 million EU citizens, with a substantial personal and socioeconomic impact. The initiation of a (life-long) treatment with disease modifying antirheumatic drugs (DMARDs) is recommended directly after the diagnosis of RA. Whenever a patient does not reach remission, DMARD therapy should be adapted in the context of a shared decision making (SDM) process between the patient and healthcare provider. One of the critical factors for achieving these therapeutic benefits lies in the patient adherence to DMARD regimens ranging from 20% to 80%.

Objectives
The SQUEEZE consortium has set out to maximise the impact of DMARDs in RA (by squeezing the most out of existing drugs) using clinical, laboratory, molecular, digital and behavioural biomarkers to:

• select the right DMARD for a specific patient at a specific point of his/her therapeutic journey;
• optimise the DMARD regimen (dose, route);
• inform an eHealth facilitated integrated care model.

Within the SQUEEZE consortium, the Basel project team is responsible for work package 8 (WP8). Its overarching objective is to:

• develop, implement and pilot test the SQUEEZE eHealth facilitated integrated care model including digital therapeutics (SCM-DTx) focusing on patient´s preferences and needs to increase adherence to prescribed drugs.

Methods

The overall conceptual approach of SQUEEZE is underpinned by a complementary methodological approach to address its objectives. SQUEEZE is committed to have a highly inter-professional interdisciplinary approach combining clinical and biological approaches in combination with behavioural and psychosocial digital approaches, implementation, and computer sciences, to address its objective. In total, the SQUEEZE work programme includes 9 thematically different work packages (WPs) that are supported by three pillars: (1) Selection of DMARDs; (2) optimising DMARDs; and (3) embedding the evidence from both into an innovative model of care (WP8).

The SQUEEZE WP8 project will be interlinked with the other SQUEEZE WPs. Using principles of chronic illness care and precision medicine, WP8 will combine implementation, behavioural and agile computer science methods to ensure real-world translation. Together with our partners, we will use a step-wise approach to develop, implement and evaluate the SCM-DTx, including:

• Development of an agile stakeholder involvement and evaluation strategy at the European and Swiss levels.
• Contextual analysis at the European and Swiss levels using a multi-methods approach.
• Co-creation of the SCM-DTx with end users, including implementation strategies to support real-world translation.
• Implementation and evaluation of the SCM-DTx using a hybrid effectiveness-implementation design.

Expected Benefit / Relevance
The work programme proposed by the SQUEEZE consortium is a truly interrelated collaboration of leading centres in Europe that have come together for synergy and added value for addressing the objectives in a way that each one alone would not be able to. Within SQUEEZE WP#8, we will develop a novel eHealth-facilitated care model which includes personalised digital biomarkers to increase DMARDs effectiveness through optimized patient’s medication adherence and patient/clinician’s shared decision making. The participative and systematic approach has promising potential to improve the health outcomes of this population and – if proven effective – be a game changer in the lives of people with RA.