Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study

Abstract

Background The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. Objective The goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. Methods A nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period. Results A total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%). Conclusions Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences.

Telehealth in Rheumatology: The 2021 Arab League of Rheumatology Best Practice Guidelines

“…However, the lack of a structural framework for telerheumatology has been identified as a barrier to the effective implementation of telehealth in the rheumatology clinic [10]. [9] Best practice guidelines (BPG) for telerheumatology can provide the necessary framework to facilitate rheumatology teleconsultation as they add credibility, standardize approaches, decrease liability and facilitate reimbursement for this novel health service. [10] Nevertheless, such BPG for performing telehealth services in rheumatology and practical advice for their implementation are still lacking.…”

Digital Approaches for a Reliable Early Diagnosis of Psoriatic Arthritis

“…From a patient's point of view, a very positive attitude toward telemedicine in general and its use in rheumatology has been reported in multiple studies ( 23 , 28 – 30 ). Most notably, in a German survey study on rheumatological patients 64.4% of participants declared they would rather use telemedicine instead of regular in-person visits during follow-up ( 31 ). Surveys have also shown that general practitioners, and to an even greater extent rheumatologists, would welcome the addition of telemedicine to routine care ( 31 , 32 ).…”

“…Most notably, in a German survey study on rheumatological patients 64.4% of participants declared they would rather use telemedicine instead of regular in-person visits during follow-up ( 31 ). Surveys have also shown that general practitioners, and to an even greater extent rheumatologists, would welcome the addition of telemedicine to routine care ( 31 , 32 ). This, however, is in sharp contrast with the actual numbers of telemedicine use in rheumatology ( 31 ).…”

“…Surveys have also shown that general practitioners, and to an even greater extent rheumatologists, would welcome the addition of telemedicine to routine care ( 31 , 32 ). This, however, is in sharp contrast with the actual numbers of telemedicine use in rheumatology ( 31 ). A survey from the American Medical Association showed that short of 10% of U.S. rheumatologists used telemedicine, a relatively low number and significantly less than other specialists such as radiologists, which attested at around 43% ( 33 ).…”

“…Organizational matters, rather than clinical ones, were described as the main barriers to the introduction of telemedicine by physicians. These include limited knowledge of the topic and the need for specific training, excessive administrative expenses for the purchase of equipment, and lacking reimbursement opportunities ( 31 ).…”