Rheumatoid Arthritis Care and the Option of Telemedicine

Video telemedicine may be an option for care in rheumatoid arthritis (RA) for patients who have high disease activity and positive perceptions of telemedicine, and for physicians who frequently utilize telemedicine technologies, according to research published in Arthritis 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 synchronous video teleconference. Physicians were briefly and generally trained on the use of the telemedicine equipment. Telemedicine was made available to patients in 2 different scenarios: Those residing in rural areas could use the video teleconference to reduce travel burden, or care was provided at the Alaska Native Medical Center in Anchorage from a rheumatologist who was video-conferenced in from out of state.

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

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

Investigators conducted a multivariate analysis for age, sex, number of rheumatologist visits in the past year, Routine Assessment of Patient Index Data 3 score, telemedicine survey score, ever seen by telemedicine by any provider, and mean rheumatologist telemedicine rate. The strongest association with patient use of telemedicine was the mean rheumatologist telemedicine rate (odds ratio [OR] 4.14; 95% CI, 2.35-8.00). Additional strong associations were observed between the telemedicine perception 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 of Patient 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 nature of the research, possible unmeasured staff or provider biases that contributed to patient choice, and the unique setting that may prevent a generalization of results 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