Telerheumatology: an idea whose time has come

Abstract

Australia is a vast country with one‐third of the population living outside capital cities. Providing specialist rheumatologist services to regional, rural and remote Australians has generally required expensive and time‐consuming travel for the patient and/or specialist. As a result, access to specialist care for remote Australians is poor. Rheumatoid arthritis is a common disease, but like many rheumatic diseases, it is complex to treat. Time‐dependent joint damage and disability occur unless best evidence care is implemented. The relatively poor access to rheumatologist care allotted to nonmetropolitan Australians therefore represents a significant cause of potentially preventable disability in Australia. Telehealth has the potential to improve access to specialist rheumatologists for patients with rheumatoid arthritis and other rheumatic diseases, thereby decreasing the burden of disability caused by these diseases. Advances in videoconferencing technology, the national broadband rollout and recent Federal government financial incentives have led to a heightened interest in exploring the use of this technology in Australian rheumatology practice. This review summarises the current evidence base, outlines telehealth's strengths and weaknesses in managing rheumatic disease, and discusses the technological, medicolegal and financial aspects of this model of care. A mixed model offering both face‐to‐face and virtual consultations appears to be the best option, as it can overcome the barriers to accessing care posed by distance while also mitigating the risks of virtual consultation.

Apps for People With Rheumatoid Arthritis to Monitor Their Disease Activity: A Review of Apps for Best Practice and Quality

“…Since demand for care is predicted to increase, adoption of different models of care provision will be necessary [18,35,36]. These are likely to include telehealth and an increased emphasis on participatory health care where people with RA are active agents in the management of RA.…”

“…Apps that collect disease activity data using validated disease activity instruments may be useful in facilitating management with a rheumatologist by measuring medically credible RA activity between visits and potentially enabling some care to be provided via telehealth [18,19]. …”

Telemedicine in Rheumatology

“…Leggett et al [3] examined the diagnostic accuracy and acceptability of telemedicine in the field of rheumatology and found that the televisual consultations were highly accurate (97%) and acceptable to patients, general practitioners, and specialists. Roberts et al [4] reported on the telerheumatology experience in Australia and emphasized the need for face-to-face consultations alongside teleconsultations to ensure that deficiencies in telehealth can be addressed in specific situations.…”

Factors associated with access to rheumatologists for Medicare patients

“…Telemedicine, video conferencing, or otherwise improving access to existing practices, such as extending hours, may also play important roles in reducing travel times and thus improving access. 16,17,18 Interestingly, we found that some beneficiaries living in high-supply areas also traveled long distances to see a rheumatologist. Although more research is needed, we suspect that several factors may explain this paradox, including tertiary care referral patterns, patient preferences for particular, far-away clinicians, or lack of acceptance of public insurance.…”