Abstract:Objectives
The Covid-19 pandemic necessitated a rapid global transition towards telemedicine; yet much remains unknown about telemedicine’s acceptability and safety in rheumatology. To help address this gap and inform practice, this study investigated rheumatology patient and clinician experiences and views of telemedicine.
Methods
Sequential mixed methodology combined analysis of surveys and in-depth interviews. Between and … Show more
“…Furthermore, it is not clear to what extent the use of tele-rheumatology will influence medical-relationship building. In a multi-stage, mixed-methods study, Sloan and colleagues have investigated the acceptability of tele-rheumatology and the associated preferences and experiences among patients and clinicians, and identified limitations that could inform the development of this increasingly important approach 2 . Morsa Images/DigitalVision …”
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confidence: 99%
“…The study involved 1,340 adult patients and 111 clinicians who participated in an online survey that was conducted between April and July 2021 in the UK 2 . Additionally, in-depth interviews were performed with 31 of the patients and 29 of the clinicians.…”
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confidence: 99%
“…Patient–clinician partnership was one major issue that was assessed in the study 2 . A majority of clinicians (90%) and of patients (69%) reported that telemedicine consultations were worse (or much worse) than face-to-face consultations for relationship building.…”
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confidence: 99%
“…Notably, Sloan et al found that >60% of patients and clinicians considered telemedicine to be more convenient than face-to-face consultation, even though remote appointments did not always save the clinicians’ time 2 . These findings are consistent with those from other studies, and reflect one major advantage of telemedicine, which is that it is location independent.…”
The COVID-19 pandemic has caused a rapid transition towards telemedicine, raising concerns about assessment accuracy, medical-relationship building and potential inequalities between patient groups. For some rheumatology patients, telemedicine is convenient and acceptable, but careful selection and choice are important.
“…Furthermore, it is not clear to what extent the use of tele-rheumatology will influence medical-relationship building. In a multi-stage, mixed-methods study, Sloan and colleagues have investigated the acceptability of tele-rheumatology and the associated preferences and experiences among patients and clinicians, and identified limitations that could inform the development of this increasingly important approach 2 . Morsa Images/DigitalVision …”
mentioning
confidence: 99%
“…The study involved 1,340 adult patients and 111 clinicians who participated in an online survey that was conducted between April and July 2021 in the UK 2 . Additionally, in-depth interviews were performed with 31 of the patients and 29 of the clinicians.…”
mentioning
confidence: 99%
“…Patient–clinician partnership was one major issue that was assessed in the study 2 . A majority of clinicians (90%) and of patients (69%) reported that telemedicine consultations were worse (or much worse) than face-to-face consultations for relationship building.…”
mentioning
confidence: 99%
“…Notably, Sloan et al found that >60% of patients and clinicians considered telemedicine to be more convenient than face-to-face consultation, even though remote appointments did not always save the clinicians’ time 2 . These findings are consistent with those from other studies, and reflect one major advantage of telemedicine, which is that it is location independent.…”
The COVID-19 pandemic has caused a rapid transition towards telemedicine, raising concerns about assessment accuracy, medical-relationship building and potential inequalities between patient groups. For some rheumatology patients, telemedicine is convenient and acceptable, but careful selection and choice are important.
“…Consultation time, listening and displaying empathy were also felt to be reduced due to pandemic constraints and the large-scale transition towards telemedicine. Telemedicine was felt to be inferior to face-to-face in most respects by rheumatology clinicians and patients in our previous study [ 35 ]. Some clinicians expressed concerns that the NHS and hospital management targets for telemedicine were over-ambitious, had been decided with insufficient consultation with clinicians, and were not necessarily clinically appropriate.…”
Objective
To better understand rheumatology patient and clinician pandemic-related experiences, medical relationships and behaviours in order to help identify the persisting impacts of the Covid-19 pandemic, and inform efforts to ameliorate the negative impacts and build-upon the positive ones.
Methods
Rheumatology patients and clinicians completed surveys (Patients N = 1,543, Clinicians N = 111) and interviews (Patients N = 41, Clinicians N = 32) between April 2021 and August 2021. A cohort (N = 139) of systemic autoimmune rheumatic disease patients was also followed-up from March 2020 to April 2021. Analyses used sequential mixed methods. Pre-specified outcome measures included the Warwick-Edinburgh Mental wellbeing score (WEMWBS), satisfaction with care, and healthcare-behaviours.
Results
We identified multiple ongoing pandemic-induced/increased barriers to receiving care. The percentage of patients agreeing they were medically supported reduced from 74.4% pre-pandemic to 39.7% during-pandemic. Ratings for medical support, medical-security and trust were significantly (p< 0.001) positively correlated with patient WEMWBS and healthcare-behaviours, and decreased during the pandemic. Healthcare-seeking was reduced, potentially long-term, including from patients feeling ‘abandoned’ by clinicians, and a ‘burden’ from Government messaging to protect the NHS. Blame and distrust were frequent, particularly between primary and secondary care, and towards the UK Government, whom <10% of clinicians felt had supported clinicians during the pandemic. Clinicians’ efforts were reported to be impeded by inefficient administration systems, and chronic understaffing, suggestive of the pandemic having exposed and exacerbated existing healthcare-system weaknesses.
Conclusion
Without concerted action—such as rebuilding trust, improved administrative systems, and more support for clinicians—barriers to care and negative impacts of the pandemic on trust, medical relationships, medical-security and patient help-seeking may persist longer-term.
Trial registration
This study is part of a pre-registered longitudinal multi-stage trial, the LISTEN study (ISRCTN-14966097), with later Covid-related additions registered in March 2021, including a pre-registered statistical analysis plan.
ObjectiveDevelop a decision‐making tool to predict telehealth appropriateness for future Rheumatology visits and expand telehealth care access.MethodsThe model was developed using the Encounter Appropriateness Score for You (EASY) and Electronic Health Record (EHR) data at a single academic rheumatology practice from January 1st, 2021, to December 31st, 2021. The EASY model is a logistic regression model that includes encounter characteristics, patient sociodemographic and clinical characteristics, and provider characteristics. The goal of pilot implementation was to determine if model recommendations align with provider preferences and influence telehealth scheduling. Four providers were presented with future encounters that the model identified as candidates for a change in encounter modality (true changes), along with an equal number of artificial (false) recommendations. Providers and patients could accept or reject proposed changes.ResultsThe model performs well with an AUC from 0.831 – 0.855 in 21,679 encounters across multiple validation sets. Covariates that contributed most to model performance were provider preference for and frequency of telehealth encounters. Other significant contributors included encounter characteristics (current scheduled encounter modality) and patient factors (age, RAPID3 scores, diagnoses, medications). The pilot included 201 encounters. Providers were more likely to agree with true versus artificial recommendations (Cohen's Kappa = 0.45, p < 0.001), and the model increased the number of appropriate telehealth visits.ConclusionThe EASY model accurately identifies future visits that are appropriate for telehealth. This tool can support shared decision‐making between patients and providers in deciding the most appropriate follow‐up encounter modality.
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