Telemedicine more commonly used by patients with higher RA activity
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Video telemedicine, when it is offered, is more likely to be used by patients with rheumatoid arthritis who demonstrate higher disease activity, have more positive perceptions of the technology and whose physicians have used it more often, according to findings published in Arthritis Care & Research.
“Telemedicine is increasingly being incorporated into the clinical practice of rheumatology,” Elizabeth D. Ferucci, MD, MPH, FACP, from Community Health Services at the Alaska Native Tribal Health Consortium, told Healio Rheumatology. “There have been few studies published on tele-rheumatology, including predictors of use, clinical outcomes or cost-effectiveness.”
She added, “Although the study is designed to evaluate predictors, outcome and quality of care, this manuscript focuses exclusively on predictors of use of video telemedicine for follow-up of rheumatoid arthritis, when offered as part of usual care.”
To determine which factors are associated with the use of video telemedicine as a component of routine RA follow-up care, Ferucci and colleagues recruited 122 adults who had been seen by a rheumatologist in the Alaska Native Medical Center, part of the Alaska Tribal Health System. All participants had been seen either in person by a rheumatologist or via telemedicine, specifically synchronous video teleconference, and were enrolled from August 2016 to March 2018.
Participants at the study visit were assessed using the Routine Assessment of Patient Index Data 3 (RAPID3) index, and they completed a telemedicine perception survey. In addition, participants agreed to medical record review for demographics and disease characteristics. The researchers analyzed data from this visit to describe which factors where associated with telemedicine use in RA.
According to the researchers, 56 of the 122 participants, or 46%, had used telemedicine at least once. Factors associated with its use in univariate analysis included higher RAPID3 score, more rheumatology visits in the preceding year, a more positive perception of telemedicine and seeing a physician who uses telemedicine more often. All four factors remained significant following multivariate analysis. Neither demographic nor other disease-related factors were associated with telemedicine use.
“The findings suggest that patient and provider perceptions of telemedicine both influence how likely patients are to accept this as an option when offered as part of usual care,” Ferucci said. “In addition, the association of higher number of visits and RAPID3 score with telemedicine use suggest that higher disease activity may change the balance of perceived benefits to favor telemedicine. These findings may be useful to others planning to initiate tele-rheumatology programs.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Carrie Beach, BSN, RN-BC
With the rheumatology workforce shortage looming, we will soon be tasked with the challenge of finding creative ways to reach a wider patient base, by providing care to patients that do not have a rheumatology health care provider within a reasonable geographic distance. Telemedicine looks to be a promising option for increasing the access to proper care for this patient population.
However, as reported by Ferucci et al., getting our patients on board with this type of health care may be our biggest challenge, especially for those health care providers that have not had experience with telemedicine. Both the patient’s perception of telemedicine and the frequency of use by the health care provider were seen as driving forces for a patient’s willingness to participate in this type of care.
We need to begin the process of educating and preparing, not only ourselves, but our patients as well in regard to the practice and implementation of telemedicine. With proper education and encouragement, we can help to shape the future of rheumatologic care by using telemedicine to reach more patients.
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