Rheumatology Case Studies

North Bristol Trust

Establishing a hybrid remote clinic for patients on biological and targeted synthetic DMARDs in Rheumatology


Because current guidelines (2020-2022) require 6-monthly reviews to ensure ongoing drug efficacy, we were required to see all patients F2F 6-monthly to ascertain if they were doing well or not. Before using the app, there was no efficient way to remotely collect outcome data on our patients before they came to the clinic. Because these novel drugs are so effective, patients on these drugs often have the lowest disease activity of all our cohort, and many of these F2F appointments were unnecessary.

An audit before implementation of the service change showed that in 80% of the F2F appointments, no change was made to medication or treatment plan, suggesting many F2F appointments could be saved by transferring these to remote or virtual appointments.


To develop and deliver, in partnership with patients, a biologics service that uses a hybrid clinic model (F2F and remote) and patient reported outcome measures (using a smartphone app), to guide practice and minimise unnecessary appointments.


  • Over £70,000 has been saved per year in unnecessary appointments.
  • Our service change has freed-up over 140 hours of clinical nurse specialist time which has been reinvested in the service to improve efficiency.

Further Findings:

  • There is a potential to reduce unnecessary appointments.
  • Longitudinal ePROM data speeds up history taking.
  • ePROM data quickly highlights flares that may have happened since the last review.
  • ePROM data means that we are able to review patients asynchronously (i.e. review their data when they are not in the clinic or on the telephone).
  • ePROM data supports medication optimisation decision-making in remote clinics.
  • There is a spectrum of patient engagement—some really like recording their data, others need to be encouraged and clinical rationale for using the app needs to be explained.
  • Patient and MDT involvement is key in any service redesign.
  • Reviewing data in clinic appointments is essential to reinforce use.
  • There needs to be a clear clinical pathway and agreement with patients on how ePROMs will be used at the outset.
  • Patients need to see own data.
  • The data can be used for research and audit opportunities.

Read more on the NHS website.