Study: Telehealth Has Significant Potential to Manage, Deliver Care for Rheumatic Diseases

Telehealth has significant potential to manage and deliver care for patients with rheumatic diseases, according to a study published in ACR Open Rheumatology.¹

The researchers explained that telehealth, the use of electronic information and telecommunication technologies to support long-distance clinical care, has increased gradually in the US over the last 4 decades and dramatically during the COVID-19 pandemic; there was a 63-fold increase in telehealth visits from 2019 to 2020.

Because telehealth continues to be used extensively, the researchers sought to summarize the literature on home-based telehealth for routine rheumatology care to help inform day-to-day rheumatology practice and identify areas to prioritize for future research.

Telehealth appointment | Image Credit: fizkes - stock.adobe.com

To do so, the researchers searched electronic databases PubMed, Web of Science, and the Cochrane Library for relevant articles using keywords like telehealth and rheumatology. The articles selected had to describe the disease and patient characteristics most suited to a telehealth or in-person (F2F) rheumatology visit, describe the methods rheumatology practices used to screen patients for telemedicine visit eligibility and appropriateness, identify the most useful patient-reported outcomes (PROs) collected during telehealth encounters, and/or describe the tools used to measure patient satisfaction with telehealth.

Overall, the researchers looked for published full-length articles and brief reports on primary data focused on home-based telerheumatology. However, because it is an emerging field, they searched the European Alliance of Associations for Rheumatology and American College of Rheumatology annual meeting abstracts from 2020 to 2022. Also, the researchers hand-searched the reference lists of other relevant systematic reviews to identify articles they may have missed.

The researchers initially chose 4882 records for title and abstract screening. Of these, 277 underwent full-text review, and they included 23 articles in their final analysis. After reviewing conference abstracts, the researchers identified 10 eligible abstracts, so they included 33 articles in their final analysis.

First, they found 7 articles that discussed the suitability of telehealth for rheumatology care from Italy, Australia, the US, and the United Kingdom (UK). Key findings from these studies included that telehealth appointments are effective in streamlining care and reducing the need for F2F visits. For example, 1 study found that telehealth appointments reduced the need for a second follow-up F2F visit compared with patients who had a single F2F visit (26% vs 54%; P < .05).²

However, the researchers noted that telehealth may be less suitable for new patients with inflammatory arthritis (IA) or autoimmune connective tissue disease (CTD), but it can enhance the continuity of care for follow-up visits for patients with IA and systemic lupus erythematosus (SLE).¹

Also, the researchers found 5 articles that addressed barriers to telehealth for rheumatology patients; these studies originated from India, Japan, the UK, and the Netherlands. Through these, they determined that barriers to telehealth for patients included language differences, lack of technology, and age. In particular, the UK study indicated younger age as a predictive factor for telehealth satisfaction, as 73.9% of patients under 50 years old preferred telehealth during the pandemic compared with 57.8% of patients aged between 50 to 69 years and 46.8% of patients older than 70 years.³

Conversely, a study from the Netherlands identified telehealth barriers for physicians as the inability to perform a physical examination, difficulty in estimating the patient's physical condition, and difficulty in reaching the patients.⁴

Additionally, they identified 7 studies that assessed clinical outcomes associated with telehealth, specifically for patients with rheumatoid arthritis or SLE.¹ The key findings across studies suggested that telehealth follow-up does not lead to worse outcomes compared to F2F visits; telehealth follow-up either improves PROs or provides effective triage of patients with reduced or more efficient health care utilization. Consequently, several clinical practice outcome measures can be used during telehealth visits with patients with rheumatic diseases.

Lastly, the researchers analyzed 14 studies that explored telemedicine satisfaction. They reported high patient satisfaction, though slightly lower than F2F visits in some cases. For example, 1 study found a higher satisfaction (94% vs 84%) and a higher desire to use telemedicine in the future (83% vs 77%) among patients with rheumatic diseases in 2021 compared to 2020.⁵ Factors influencing telehealth satisfaction included educational status, age, and health literacy.¹ Conversely, providers expressed concerns about the lack of physical examinations during telehealth visits. More specifically, a study found that 82.4% of providers were unsatisfied due to the lack of physical examinations.⁵

The researchers acknowledged their study’s limitations, one being that they identified studies that had much more heterogeneity in practice settings, disease, technology, socioeconomic status, and geographic location; their findings cannot be generalized without considering these factors.¹ Also, their search strategy did not include non-English articles, which could have limited the reporting of global rheumatology telehealth practices during the pandemic. Based on these limitations, the researchers suggested areas for further research.

“Further research in the form of disease-specific RCTs [randomized controlled trials] can help confirm the findings in this review, clarifying the reliability of telemedicine visits in place of F2F ones for key patient subgroups,” the authors wrote.

Reference

1. Venuturupalli S, Peck A, Jinka Y, et al. Home-based telemedicine in rheumatology-a scoping review. ACR Open Rheumatol. doi:10.1002/acr2.11660

2. GiacobbeE,GerardiMC, Ughi N, et al. AB1406 Telerheumatology for improving first access to the outpatient clinic: a pilot prospective monocentric Italian study. Ann Rheum Dis. 2022;81(1):1808-1809. doi:10.1136/annrheumdis-2022-eular.3213

3. Raizada SR, Cleaton N, Bateman J, Mulherin DM, Barkham N. Are telephone consultations here to stay in rheumatology?. Rheumatol Adv Pract. 2020;5(1):rkaa071. doi:10.1093/rap/rkaa071

4. Bos WH, van Tubergen A, Vonkeman HE. Telemedicine for patients with rheumatic and musculoskeletal diseases during the COVID-19 pandemic; a positive experience in the Netherlands. Rheumatol Int. 2021;41(3):565-573. doi:10.1007/s00296-020-04771-6

5. Tang W, Inzerillo S, Weiner J, et al. The impact of telemedicine on rheumatology care. Front Med (Lausanne). 2022;9:876835. doi:10.3389/fmed.2022.876835