Telemedicine Improved Appointment Adherence for Rheumatology Visits

As the coronavirus disease 2019 (COVID-19) pandemic surged globally, patients and providers began postponing procedures and scaling back face-to-face visits due to the potential risk from the novel virus. In particular, rheumatology clinics and practices cut back on in-person services because their patients may be vulnerable to infection due to taking immune-suppressing drugs.

In a new abstract presented at the annual meeting of the American College of Rheumatology, researchers at a large Ohio health system highlighted how telemedicine was used to reduce cancellations and no-shows for rheumatology care and may present an option for a significant proportion of follow-up care moving forward.

“Many rheumatology patients are already at an increased risk for infection due to immunosuppressive medications and immune system dysfunction related to their diseases. While in-person visits may place patients at risk for contracting the virus, delaying care can increase the risk for disease flares and the potential need for hospitalization,” said study coauthor Reem Alkilany, MD, a rheumatology fellow at MetroHealth. “Telemedicine offered a way for rheumatology patients and providers to connect with one another in place of delayed care or even absence of care.”

MetroHealth began implementing telemedicine by video or telephone within 1 week of Ohio issuing a statewide order to limit gatherings in March 2020. The researchers sought to compare completed visits, no-shows, and cancellation rates between in-person and telemedicine appointments after hearing anecdotal evidence that rheumatology providers were seeing improved clinic show rates with telemedicine.

They collected data retrospectively using Reporting Workbench in the Epic electronic health record. They divided the data into 2 periods:

• Period 1: the pre–COVID-19 interval from January 3, 2020, to March 15, 2020. The only modality was in-person visits.
• Period 2: during the COVID-19 pandemic (March 16, 2020, to May 31, 2020). Telemedicine began taking place as well as in-person visits.

Out of 825 telemedicine appointments offered during period 2, there was only 1 cancellation (<1%). In comparison, there had been 527 cancellations out of 1677 in-person appointments (31%) in period 1. No-shows were also down: There were 121 in-person no-shows and 70 telemedicine no-shows in period 2 (n = 191) compared with 220 no-shows during period 1 when only in-person appointments were offered.

There were a total of 1675 scheduled visits during period 2, and 1038 (754 telemedicine and 284 in person) were completed (62%). In comparison, there were 1677 scheduled visits during period 1 and only 930 completed visits (55%).

The authors encourage considering the use of telemedicine as part of routine clinic visits to improve patient adherence to appointments. Alkilany added that MetroHealth’s Division of Rheumatology is going to aim to perform 40% of future follow-up visits through telemedicine.

“Visits that require diagnostic or therapeutic procedures, such as joint injection or ultrasound, will always require in-person visits and a physical exam,” she said. “Although in-person visits cannot always be replaced by phone or video visits, we believe that telemedicine's potential to increase the accessibility and convenience of healthcare makes it an essential component to the future of medicine.”

Reference

Alkilany R, Hong R. Telemedicine visits during COVID-19 improved clinic show rates. Presented at: ACR Convergence 2020; November 5-9, 2020; Abstract 1584. https://acrabstracts.org/abstract/telemedicine-visits-during-covid-19-improved-clinic-show-rates/