Future challenges in rheumatology – is telemedicine the solution?

Abstract

The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.

The Use of Remote Consultations and Associated Factors in Rheumatology: A Large Retrospective Cohort Study of Follow‐Up Consultations Before, During, and After COVID‐19

“…Our results show that use of VCs was relatively low, as reported in previous research 11,27,28 . Reasons for this might be that both patients and HCPs experienced barriers in the use thereof, such as lack of the right equipment and technical barriers 29,30 . It is unclear yet whether VCs offer added value compared with telephone consultations because research reports similar consultation quality between telephone and video consultations, and demand by patients is low 31,32 .…”

“…11,27,28 Reasons for this might be that both patients and HCPs experienced barriers in the use thereof, such as lack of the right equipment and technical barriers. 29,30 It is unclear yet whether VCs offer added value compared with telephone consultations because research reports similar consultation quality between telephone and video consultations, and demand by patients is low. 31,32 Therefore, it is important to investigate the added value of video consultations compared with telephone consultations, before (often costly) implementation initiatives are taken to overcome the barriers experienced in using VCs.…”

Telemedicine in Rheumatoid Arthritis: A Review of the PubMed Literature

“…Also, more well-designed studies are needed to pinpoint potential limiting factors on RA patients’ access to telemedicine delivery. Factors such as data confidentiality and patient privacy issues, 9 and inequities in accessing telemedicine care such as in RA patients in terms of geographic location, age, education, and socioeconomic status 43 must be covered to better understand telemedicine in the management of RA patients. Clinical service providers should continue to provide in-person care services considering patients who have limited or no internet access.…”

Impact of the COVID‐19 Pandemic on Health Care Access and Diagnosis of Pulmonary Arterial Hypertension Among Patients With Systemic Sclerosis

“…In March 2020, in response to the COVID‐19 pandemic, Australian rheumatology clinics switched to delivering consultations by telehealth to reduce transmission of the highly contagious virus. World Health Organization defines telehealth as “the use of telecommunications and virtual technology to deliver health care outside of traditional health‐care facilities.” 3 Despite telehealth being contemplated in rheumatology clinics for more than two decades before the pandemic, 4 face‐to‐face consultation had been the default modality.

During the first two years of the COVID‐19 pandemic, patients with systemic sclerosis in Australia reported significant disruption and compromise of health care for their systemic sclerosis, whereas difficulty accessing community‐based health care such as general practitioners and pharmacy access for medications was less frequent. Nearly two‐thirds of rheumatology consultations were by telehealth, of which the vast majority were by telephone. In the state of Victoria, where the COVID lockdown was one of the longest in the world, continuing for a total of 262 days, patients reported even higher rates of health care interruption and worse mental health. Patients also reported reduced access to screening for pulmonary arterial hypertension (PAH), and the median incidence of newly diagnosed PAH was reduced by 90.3% from 1.33% in 2011 to 2019 to 0.24% in 2020 to 2022. The impact of delayed diagnosis and treatment of PAH is yet to be determined.

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“…World Health Organization defines telehealth as "the use of telecommunications and virtual technology to deliver health care outside of traditional health-care facilities." 3 Despite telehealth being contemplated in rheumatology clinics for more than two decades before the pandemic, 4 face-to-face consultation had been the default modality.…”