Using electronic visits (E-visits) to achieve goal serum urate levels in patients with gout in a rheumatology practice: A pilot study

Yokose, Chio; Jorge, April; D’Silva, Kristin M; Serling‐Boyd, Naomi; Matza, Mark; Nasrallah, Mazen; Keller, Sarah F.; Oza, A.; Choi, Hyon K.; Bolster, Marcy B.; Collier, Dean S.

doi:10.1016/j.semarthrit.2020.03.001

Cited by 9 publications

(9 citation statements)

References 18 publications

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“…This mechanism has been used to improve treat-to-target in gout care. [38] There are many limitations to this form of telemedicine as it is currently not widely available and is less likely to be reimbursed by insurance companies. The advantages however are easily identifiable in reducing the need for travel time for patients when a face-to-face visit may not be necessary.…”

Section: Telemedicinementioning

confidence: 99%

Addressing the rheumatology workforce shortage: A multifaceted approach

Miloslavsky

Bolster

2020

Seminars in Arthritis and Rheumatism

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A significant challenge facing the field of rheumatology is the projected gap between the growing demand for rheumatologists and the available workforce. In order to improve access to care, augmenting the rheumatology workforce is required. Herein we discuss potential solutions to the anticipated workforce shortage, including 1) expanding the training of rheumatology physicians; 2) increasing nurse practitioner, physician assistant and pharmacist utilization in rheumatology practice; 3) growing the use of telemedicine; and 4) reducing burnout in order to retain practicing rheumatologists. Building on the existing literature in these areas, we propose a multifaceted approach to addressing the rheumatology workforce shortage.

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Section: Telemedicinementioning

confidence: 99%

Addressing the rheumatology workforce shortage: A multifaceted approach

Miloslavsky

Bolster

2020

Seminars in Arthritis and Rheumatism

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“…In the same study, e-visits for anticoagulant management were associated with less frequent instances of abnormal international normalized ratio values compared to in-person care (5/104, 5% vs 1/198, 0.5%, P< .05) [ 44 ]. An additional study (n=62) reported that patients with gout who received care through e-visits were more likely to have optimal serum rate levels (>6.0 mg/dL) (63.8% vs 33.9%, P< .01) and lower mean serum urate levels (5.5 mg/dL vs 6.7 mg/dL, P< .01) compared to historical controls [ 31 ]. In the context of acne and hypertension management, equivalent outcomes were reported between e-visits and in-person visits [ 38 , 45 ].…”

Section: Resultsmentioning

confidence: 99%

“…Health care organizations have also raised concerns about the quality of care provided through e-visits, such as the potential for inappropriate antibiotic prescribing and difficulties with providing care without being able to see the patient face-to-face [ 22 - 29 ]. Despite these challenges, studies have reported positive effects of e-visits on health care delivery, such as lower costs [ 24 ], comparable follow-up rates to those of in-person care (ie, a proxy for diagnostic accuracy) [ 30 ], and comparable or improved patient outcomes (eg, lower uric acid level for patients with gout) [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Nguyen¹,

Tabriz²,

Huo³

et al. 2021

J Med Internet Res

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Background Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. Objective To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. Methods We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impacts on clinical and health care delivery outcomes. Results Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. Conclusions Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits.

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“…A study by Yokose et al (9), in which an e-visit conducted in 62 patients with gout was compared to a matched historic cohort, showed that SUA target of ≤6 mg/dl was obtained in 63% of patients in the intervention group versus 33% in the historic matched group. Our results were superior, likely because the Yokose et al study used email reminders and questionnaires, while we conducted phone calls in real-time with patients.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and Outcomes of a Novel Telephone-based Gout Disease Management Program

Harash

Sharma

Laginya

et al. 2020

Preprint

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Objective: Gout is the most common inflammatory arthritis in the United States. Despite published guidelines, management remains suboptimal, leading to unnecessary morbidity and increased cost of care. We have designed the gout disease management program (GDMP) to improve outcomes, increase patient satisfaction and decrease healthcare utilization.Methods: Gout patients were seen at their usual rheumatology clinical visit and offered participation in the GDMP. Data were collected between April 2017 and May 2019. Serum uric acid (SUA) levels were measured at initial outpatient encounter, at entrance to GDMP and every 4 weeks until SUA was at goal of ≤6 mg/dl. During telephone encounters, gout-related recent hospitalizations and ER or urgent care visits since last encounter were ascertained. Self-reported gout medication usage and adherence were also determined. Patient satisfaction with GDMP was surveyed using a 5-point Likert scale.Results: A total of 158 patients were enrolled, of which 112 had ≥ 1 telephone encounter and were included in our analyses. During the telephone phase, 79 patients (70%) achieved SUA goal of ≤6.0 mg/dl, while90 patients (80%) achieved an acceptable SUA of ≤6.5 mg/dl. Only 3 patients (2.6%) required hospitalization or visits to an ER or urgent care center due to gout flare, and 98% rated their encounter as a 5 on the 5-point Likert scale.Conclusion: Our telephone-based management program for gout led to improved clinical outcomes as defined by the ACR guidelines, decreased healthcare visits, and had high patient satisfaction.

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Using electronic visits (E-visits) to achieve goal serum urate levels in patients with gout in a rheumatology practice: A pilot study

Cited by 9 publications

References 18 publications

Addressing the rheumatology workforce shortage: A multifaceted approach

Addressing the rheumatology workforce shortage: A multifaceted approach

Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review

Efficacy and Outcomes of a Novel Telephone-based Gout Disease Management Program

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