Patients’ Experiences and Outcomes With Virtual Care in Rheumatoid Arthritis

Satisfaction among patients with rheumatoid arthritis (RA), along with disease activity, remain stable with the use of virtual care, with the COVID-19 pandemic having played a large role in increasing the use of telemedicine, according to findings published in Arthritis Care & Research.

The investigators sought to perform a systematic review of outcomes among patients with RA who received treatment with virtual care compared with those who received conventional care. Observational and randomized controlled trials (RCTs) that describe the use of RA virtual care supplanting conventional office visits, with reports on disease activity and/or patient experience/satisfaction were included in the review. A total of 352 studies were identified, with 6 chosen for final inclusion. Of these studies, 3 were observational and 3 were RCTs. The 6 studies—all of which had been published in or after 2016—comprised a total of 1159 patients with RA.

In the studies, virtual care modalities included telephone calls, video conferences, web-based platforms, mobile applications, or electronic consultations. All of the virtual care visits analyzed needed to supplant an inperson rheumatology visit. Any study that used these modalities for other purposes, such as primarily patient education or enhanced patient supports, were excluded from the analysis.

The studies were conducted in the US, Canada, Singapore, Egypt, and Denmark. The 6 studies were representative of both urban and rural settings. Although one of the studies focused on a population of patients with early RA, the other 5 studies included patients who had more established RA.

Results of the review demonstrated that disease activity and patient experiences were similar between the virtual and conventional care models. Further, one of the RCTs reported no differences in any observed outcomes between virtual care delivered by a rheumatologist and virtual care delivered by a rheumatology nurse.

Benefits of virtual care included improved treatment adherence, enhanced quality of life, and maintenance of functional status. In 2 of the 3 RCTs, the overall risk for bias was low; however, that risk was high in the 3 observational studies.

The quality of the studies reviewed was limited by lack of sample size justification, incomplete data reporting, and insufficient timeframe to evaluate the objectives.

The investigators concluded that additional research into effective implementation strategies, together with long-term health system and patient outcomes associated with the use of virtual care, is warranted. They noted that “despite the relative lack of data currently on the use of virtual modalities in the management of RA patients, it is clear that this method of care has the potential to be a useful tool [for] the current healthcare model.”

Reference

Han L, Hazlewood GS, Barnabe C, Barber CEH. Systematic review of outcomes and patient experience with virtual care in rheumatoid arthritis. Arthritis Care Res . Published online March 1, 2021. doi: 10.1002/acr.24586