Experiences of a patient-initiated self-monitoring service in inflammatory arthritis: A qualitative exploration

Objectives To explore patients’ experience of a patient-initiated self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate. Methods Qualitative semi-structured interviews, embedded within a randomized controlled trial. Twelve participants who were randomly assigned to the intervention arm were interviewed. Interviews were digitally recorded, transcribed verbatim and analysed using inductive thematic analysis. The study received full NHS ethics approval from Camden and Islington Community Local Research Ethics Committee (Ref. 09/H0722/91). Results Analysis revealed five key themes. Participants described usual care as burdensome and an inefficient use of time, particularly those in employment. Being able to self-monitor and initiate their own care increased patients’ knowledge about their illness and its treatment, and enabled them to gain a sense of control and ownership over their arthritis. Patients appreciated the personalised nature of the new service, which allowed them to be seen at a time and by a method more appropriate to their needs. There was however some concern about fidelity to the service protocol, confusion about the lack of consistency between symptoms and laboratory results and anxiety about self-monitoring. Conclusions Overall, participants were positive about the new service, in comparison to usual care, valuing its tailored approach and empowering effects. Further work is needed to ensure adherence to the service protocol and address anxieties around self-monitoring prior to any widespread implementation of the service