What Is the Effect of Telerheumatology on Patient Care During the COVID-19 Pandemic?

The effect of telerheumatology on patient care during the COVID-19 pandemic was studied, and these data were published in Rheumatology. In a retrospective study of patients who transitioned to receiving rheumatology care via telemedicine, diagnostic delays were observed; however, appointment attendance improved compared to the prepandemic period.

While previous research suggests that telerheumatology is feasible and acceptable for patients during the pandemic, its effect on patient care remains unclear.

To examine the effects of telerheumatology and COVID-19 on outcomes, the study authors conducted a retrospective audit of electronic medical records from participating rheumatology clinics in Melbourne, Australia. Data from April and May 2019 were compared to data from April and May 2020. Mann-Whitney U and Chi-square tests were used to assess differences in baseline variables between the cohorts. Univariate analyses were used to estimate odds ratios (ORs) and identify correlates of requiring a subsequent face-to-face visit following a telerheumatology consultation.

Data from 3040 appointments (1443 from 2019 and 1597 from 2020) were examined. No significant between-cohort differences were observed regarding age, sex, percentage of new and returning patients, and frequency of immunosuppressant use. The most common rheumatologic diagnoses were inflammatory arthritis (35.1%), lupus or connective tissue disease (25.3%), and vasculitis (8.4%). Inflammatory arthritis was a more common diagnosis in 2020 compared to 2019 (35.1% vs 31.0%; P =.024). In 2020, 96.7% of appointments were conducted via telerheumatology by telephone.

In patients without an existing rheumatologic diagnosis, the odds of receiving any diagnosis were significantly lower in 2020 compared to 2019 (28.6% vs 57.4%, respectively; OR, 0.30; 95% CI, 0.16-0.53; P <.001). Clinicians were less likely to prescribe changes in immunosuppressive therapy in 2020 vs 2019 (22.6% vs 27.4%, respectively; OR, 0.78; 95% CI, 0.65-0.92; P =.004), a change that was mostly driven by a lower incidence of therapy de-escalation (10.0% vs 12.6%, respectively; OR, 0.75; 95% CI, 0.59-0.95; P =.019). From the findings, the study authors suggested that clinicians wanted to minimize risk for flares during the pandemic and therefore avoided immunosuppressive therapy changes.

Appointment nonattendance was substantially lower in 2020 compared to 2019 (6.5% vs 10.9%, respectively). Predictors of needing a face-to-face appointment in 2020 were being a new patient (OR, 6.28; 95% CI, 4.10-9.64; P <.001), not having a rheumatologic diagnosis (OR, 18.43; 95% CI, 2.35-144.63; P =.006), having a diagnosis of inflammatory arthritis (OR, 2.85; 95% CI, 1.40-5.80; P =.004), or having a diagnosis of lupus or connective tissue disease (OR, 3.22; 95% CI, 1.11-9.32; P =.031).

Data from this study corroborate prior findings that suggest telemedicine may have lower diagnostic confidence and accuracy compared to in-person patient care. Telemedicine was also associated with lower odds of treatment alteration, despite improved appointment attendance rates during 2020.

“While the effects of telerheumatology cannot be differentiated from changes in practice related to the pandemic, these findings suggest telephone-based telerheumatology may have a negative impact on the timeliness of management of patients [with rheumatologic conditions],” the study authors wrote.

Reference

Zhu W, De Silva T, Eades L, et al. The impact of telerheumatology and COVID-19 on outcomes in a tertiary rheumatology service: a retrospective audit. Rheumatology (Oxford). Published online March 1, 2021. doi:10.1093/rheumatology/keab201