The Challenges of Telemedicine in Rheumatology

Song, Yujie; Bernard, Laurène; Jørgensen, Christian; Dusfour, Gilles; Pers, Yves‐Marie

doi:10.3389/fmed.2021.746219

Cited by 22 publications

(27 citation statements)

References 40 publications

(51 reference statements)

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“…Historically, uptake of telemedicine has been low owing to difficulties in accessing technology, patients missing face-to-face contact with health-care providers, patients fearing that they might miss important clinical information, and reimbursement issues [ 10–14 ]. Significant differences between countries in telemedicine regulation and data protection also pose barriers to uptake [ 12 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Machado

Verschueren

Grainger

et al. 2022

Rheumatology Advances in Practice

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Objectives We aimed to describe, from the perspective of rheumatologists in Europe, how the COVID-19 pandemic has impacted their management of people with rheumatoid arthritis (RA) and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific Programme™ in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour, and continuing education due to COVID-19. Results were summarised with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilisation of video/telephone consultations (66.5% of respondents), fewer visits (58.5%), and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated prescribing behaviour had changed switched their patients to self-administered medication and 60.7% reported not starting patients on targeted synthetic disease-modifying antirheumatic drugs (DMARDs), biologic originator DMARDs, or biosimilar DMARDs. In total, 57.6% of rheumatologists believed changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusions All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to better prepare for future pandemics and to address ongoing rheumatologist shortages. Lay Summary What does this mean for patients ? We asked rheumatologists a series of questions to find out how COVID-19 affected the way they interact with their patients with rheumatoid arthritis. We found that rheumatologists switched to online or telephone appointments in most countries to obey social distancing rules. Rheumatologists also reduced prescription of advanced medicines, most likely as a response to patient fears that such therapies may increase infection risk. There were differences between countries in changes made to patient treatment likely caused by differences in COVID-19 case numbers and where patients saw their doctor. We also found that doctor education moved mostly online. These results will help guide doctors in case of future pandemics as well as helping to plan future studies into how online appointments may be best used, who they are suitable for, and how they may be used to ensure patients can see a rheumatologist when they need to. They also highlight a need for continued monitoring of patients to ensure medication changes do not reduce effectiveness of treatment in the long-term.

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Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Machado

Verschueren

Grainger

et al. 2022

Rheumatology Advances in Practice

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“…Despite its potential for expanding rheumatology services, use of telemedicine may inadvertently exacerbate existing disparities in care through the ’digital divide’ [15–17]. This refers to disparities in access and utilization of telemedicine related to social, language, financial, and other barriers among diverse communities by race/ethnicity and socioeconomic characteristics [15,18 ▪ ].…”

Section: Introductionmentioning

confidence: 99%

Healthcare disparities in telemedicine for rheumatology care

Jackson

Danila

2022

Current Opinion in Rheumatology

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Purpose of reviewWe summarize the recent literature published in the last 2 years on healthcare disparities observed in the delivery of rheumatology care by telemedicine. We highlight recent research dissecting the underpinnings of healthcare disparities and identify potentially modifiable contributing factors. Recent findingsThe COVID-19 pandemic has had major impacts on care delivery and has led to a pronounced increase in telemedicine use in rheumatology practice. Telemedicine services are disproportionately underutilized by racial/ethnic minority groups and among patients with lower socioeconomic status. Disparities in telemedicine access and use among vulnerable populations threatens to exacerbate existing outcome inequalities affecting people with rheumatic disease.

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“…The increasing demand during the pandemic for healthcare resources, a soaring number of patients and limited physician availability galvanized the utilization of telemedicine in Rheumatology and other specialties ( 4 ). While in-person rheumatology practice was largely replaced by telemedicine to ensure the safety of both patients and providers, the implementation of telemedicine was challenging ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

The Impact of Telemedicine on Rheumatology Care

et al. 2022

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BackgroundThe pandemic disrupted the care of patients with rheumatic diseases; difficulties in access to care and its psychological impact affected quality of life. Telemedicine as an alternative to traditional face-to-face office visits has the potential to mitigate this impact.ObjectiveTo evaluate patient and provider experience with telemedicine and its effect on care.MethodsWe surveyed patients with rheumatic diseases and their rheumatology providers. The surveys were conducted in 2020 and repeated in 2021. We assessed data on quality of care and health-related quality of life.ResultsHundred patients and 17 providers responded to the survey. Patients reported higher satisfaction with telemedicine in 2021 compared to 2020 (94 vs. 84%), felt more comfortable with (96 vs. 86%), expressed a stronger preference for (22 vs. 16%), and higher intention to use telemedicine in the future (83 vs. 77%); patients thought physicians were able to address their concerns. While providers' satisfaction with telemedicine increased (18–76%), 14/17 providers believed that telemedicine visits were worse than in-person visits. There were no differences in annualized office visits and admissions. Mean EQ-5D score was 0.74, lower than general population (0.87) but equivalent to a subset of patients with SLE (0.74).ConclusionOur data showed a high level of satisfaction with telemedicine. The lower rheumatology provider satisfaction raises concern if telemedicine constitutes an acceptable alternative to in-person care. The stable number of office visits, admissions, and the similar quality of life to pre-pandemic level suggest effective management of rheumatic diseases using telemedicine/in-person hybrid care.

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The Challenges of Telemedicine in Rheumatology

Cited by 22 publications

References 40 publications

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Healthcare disparities in telemedicine for rheumatology care

The Impact of Telemedicine on Rheumatology Care

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