Early last year, Unboxed worked with the rheumatology team and patients at Guy’s and St. Thomas’ NHS Foundation Trust to launch a new digital service supporting patients with long-term conditions such as rheumatoid arthritis.

Our hypothesis was that by engaging patients via SMS messaging and asking them to report their monthly status using an online Patient Reported Outcome Measures (PROM) form, the team would be able to provide patients with high quality, personalised care, without the need for them to routinely attend unnecessary face-to-face appointments at the hospital.

You can see a presentation on our approach and the resulting remote monitoring service here.

The proof-of-concept service now has over 100 patients fully on-board and anecdotal evidence suggests it’s already delivering huge value. With 12 months of data, it is currently undergoing formal evaluation with support from Public Health England and the Health Innovation Network but plans to extend the trial to four additional trusts across the SE London STP have been paused due to the current COVID-19 crisis.

The challenge of supporting non-urgent patients away from the hospital has never been more apparent or important and we’d like to do what we can to move this concept along.

Building on the learnings

Whilst a small number of our planned projects have been delayed, we are fortunate at Unboxed to be relatively unaffected by the current crisis. Many projects are continuing and we have always been well-placed to work and collaborate remotely. It does mean, however, that we have a few members of the team (including three new joiners) available to work on our own product ideas.

We’ve decided to pick up on the idea of PROM and test the concept across multiple illnesses and with an even more patient-centred approach. One of the issues currently facing specialist healthcare teams across the country is the lack of joined up information on patients with multiple conditions, or comorbidities. The rheumatology patients we have met at GSTT may also suffer from diabetes and many physical conditions are often accompanied by mental health issues such as anxiety or depression.

Over the next few weeks, our team will be creating an application to support the use of a range of different types of PROM in combination, including those designed for physical conditions like the Psoriatic Arthritis Impact of Disease (PSAID) form and others for mental health conditions like the General Anxiety Disorder (GAD7) and the Patient Health Questionnaire (PHQ9) for depression.

We know the use of these questionnaires to measure the impact of medical interventions on specific conditions has been validated by thorough research and we must be careful not to tamper with them too much, but we are keen to see how they might help provide a more holistic picture of a patient’s health status that is of value to both clinicians and the patient themselves.

If you’d like to follow progress on project Promenade, or even provide some input to the process, please contact Martyn Evans at martyn.evans@unboxed.co.