Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association

Abstract

Objective To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association's (CRA) Telehealth Working Group (TWG). Methods Four members of the TWG representing adult, pediatric, university-based and community rheumatology practices defined the scope of the project. A rapid literature review was conducted between April-May 2021 of existing systematic reviews, policy documents and published literature and abstracts on the topic. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set. Results 21 (95%) panelists participated in R1, 15 (71%) in R2 and 18 (82%) in R3. All but one statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex co-management of disease. Conclusion The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned.

Virtual Care Use in Primary Care or Specialty Care Settings

“…Musculoskeletal specialties Barber et al (2022) • "Rheumatologists should adhere to national recommendations on best practices, and provincial standards and regulations for virtual care, including licensing considerations, patient privacy, confidentiality, documentation, and consent.…”

“…Wahezi et al, 2020 reported on a reference guide for musculoskeletal and neurologic examination that can be used in telemedicine practice. Barber et al, 2022, who included a rapid literature review and a subsequent Delphi process, reported on quality and patient safety considerations when developing the best practice statements for rheumatology virtual care. The recommendations from those articles are listed in Table 5.…”

Never Let a Crisis Go to Waste

“…Affleck (2022: 40) makes a forceful call for "greater definitional and taxonomic rigour and the support of an established equity framework" to better address digital health equity. In their consensus statement on best practices for virtual care, the Canadian Rheumatology Association applied an equity lens to identify 10 equity-related factors and associated considerations for the decision making on virtual care versus in-person care (Barber et al 2022). Equitable access to high-quality healthcare, whatever the mode, is important, but the issue is broader.…”

“…In his 2021 paper, Falk called for specialty societies to develop specialty-specific guidelines, and the Canadian Medical Protective Association (CMPA) supports this call in a recent White Paper (CMPA 2022; Falk 2021). The Canadian Rheumatology Association took an interesting approach to this in its 2022 consensus statement (Barber et al 2022). It classified seven reasons for the clinical encounter, ranging from reviewing test results to undifferentiated disease, and assessed them against clinical considerations, type of virtual care available and preference and access considerations.…”

Big data analyses and individual health profiling in the arena of rheumatic and musculoskeletal diseases (RMDs)

“… 105 All these advancements might need standard frameworks and regulations as well as manuals for rheumatology practitioners to act in a legal, best-practice, and financially reimbursed space. 106 In particular for mhealth tools like apps for monitoring of symptoms and impact of disease clinics and investigators have tested different concepts for use in clinical care and connection to their registers. App-based assessment is similarly accepted by patients as completing PRO measures in the clinic, a discussion about the patient scores on PROs may even improve the patient-physician relationship.…”