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Video telemedicine may be anoption for care inrheumatoid arthritis (RA) for patients who have high disease activity andpositive perceptions of telemedicine, and for physicians who frequently utilizetelemedicine technologies, according to research published inArthritis Care and Research.

Using data from patients within the Alaska Tribal Health System, researchers sought to determine the baseline factors associated with the use of telemedicine for RA. Adults 18 and older with an RA diagnosis who were seen at the Alaska Native Medical Center between August 2016 and March 2018 were invited to participate in the study.

Throughout the baseline enrollment period,rheumatology-specific telemedicine was available in the form of synchronousvideo teleconference. Physicians were briefly and generally trained on the useof the telemedicine equipment. Telemedicine was made available to patients in 2different scenarios: Those residing in rural areas could use the videoteleconference to reduce travel burden, or care was provided at the AlaskaNative Medical Center in Anchorage from a rheumatologist who wasvideo-conferenced in from out of state.

In total, 122 patients participated in the study. In boththe telemedicine and in-person groups, patient demographics were similar withrespect to age, sex, and disease duration (mean 10 years). A majority ofparticipants across both groups had positive autoantibodies (>85% positivefor rheumatoid factor and anticyclic citrullinated peptide), and almost allpatients had been prescribed disease-modifying antirheumatic drugs within thelast year.

Both groups had a mean number of rheumatology visits withinthe past year higher than 2; however, the telemedicine group had more visitsoverall (mean 2.95 vs 2.39;P=.011).The telemedicine group also had higher survey scores, which indicated morepositive perceptions of telemedicine and a higher mean rheumatologisttelemedicine rate, indicating that they were seeing a rheumatologist whoperformed telemedicine visits more frequently.

Investigators conducted a multivariate analysis for age,sex, number of rheumatologist visits in the past year, Routine Assessment ofPatient Index Data 3score, telemedicine survey score, ever seen bytelemedicine by any provider, and mean rheumatologist telemedicine rate. Thestrongest association with patient use of telemedicine was the meanrheumatologist telemedicine rate (odds ratio [OR] 4.14; 95% CI, 2.35-8.00).Additional strong associations were observed between the telemedicineperception survey score and use of telemedicine (OR 2.76; 95% CI, 1.32-6.18),the number of rheumatologist visits in the past year, and Routine Assessment ofPatient Index Data 3 score.

In addition, patient perceptions of telemedicine were an important factor associated with the choice to use telemedicine for RA follow up vs in-person care only. Survey results indicated that patients who had ever been seen by telemedicine responded more favorably than those who had not. Overall, patients still preferred to be seen by a specialist in person, regardless of group (61% of the telemedicine group and 74% of the in-person-only group), but those in the telemedicine group were more likely to feel that care provided via video was as good as care provided in person.

Limitations to the study included the observational natureof the research, possible unmeasured staff or provider biases that contributedto patient choice, and the unique setting that may prevent a generalization ofresults to other populations.

Future studies will investigate disease activity over time and quality of care for RA in the setting of telemedicine compared [with] usual care and will help inform practice further, the researchers concluded.

Reference

Ferruci ED, Holck P, Day GM, Choromanski TL, Freeman SL.Factors associated with use of telemedicine for follow-up of rheumatoid arthritis[published online August 17, 2019].Arthritis Care Res.doi: 10.1002/acr.24049

Original post:
Rheumatoid Arthritis Care and the Option of Telemedicine - Rheumatology Advisor

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