Adherence To Psoriasis Remote Monitoring And Its Associations With Demographic, Clinical, And Health Care Use Characteristics: Multicenter Observational Study

Background: Psoriasis is a lifelong, relapsing, quick-to-flare skin disease that requires personalized, continuous management. Due to its unpredictable nature, there is an increasing interest in using electronic patient-reported outcome measures (ePROMs) for remote monitoring of the condition. However, adherence to ePROMs and predictors of adherence have not been sufficiently explored among patients with psoriasis. Objective: This study aimed to assess the adherence to ePROMs and the factors associated with adherence among patients with psoriasis. Methods: We conducted an observational study that spanned multiple centers to measure adherence to ePROMs among 55 patients managed in primary care and 55 patients managed in specialized care over 12 months. We analyzed the data together with longitudinal health care data recorded in Estonia’s countrywide health insurance database—a unique dataset previously unavailable to researchers studying remote monitoring. While continuing their routine clinical care, patients were periodically prompted to complete ePROMs. Adherence to remote monitoring was evaluated in relation to a range of demographic, clinical, and health care use factors using ordinal logistic regression. Results: A total of 102 patients (male: n=49, 48%; female: n=53, 52%) were included in the adherence calculation, including 46 (45.1%) patients in the high-adherence group, 22 (21.6%) in the medium-adherence group, and 34 (33.3%) in the low-adherence group. The total mean adherence ratio was 63.4% (SD 30.8%). The mean adherence ratio was 60.9% (SD 32.8%) among patients in primary care and 66.0% (SD 28.9%) among patients in specialized care. In multivariable ordinal logistic regression, older age was associated with higher adherence (P=.03). No significant associations were observed for the other investigated factors. Conclusions: This study adds to existing research on the use of ePROMs in chronic diseases by demonstrating the feasibility of using ePROMs for remote monitoring of chronic skin diseases across different levels of care. The findings provide insights into factors associated with adherence, which may inform the development of tailored approaches to improve the effectiveness of remote monitoring in psoriasis. Importantly, adherence remained strong among older adults, supporting broader implementation of ePROM-based remote care.