The long-term use of various remote- and technology-based care modalities in the field of rheumatology holds promise for relieving disparities in care in individuals with limited access due to geographic barriers, according to study data published in the Journal of Clinical Rheumatology.
The researchers conducted a longitudinal evaluation to assess patient-centered data based on a telemedicine care program and compared the results with those obtained with usual care. Veterans with previously diagnosed inflammatory arthritis who in the past had received arthritis care at the investigators’ local tertiary medical center and primary care at affiliated secondary and tertiary care sites were identified and enrolled in a prospective 12-month pilot telemedicine program. Data were collected longitudinally prior to and following study enrollment, including Routine Assessment of Patient Index Data 3 (RAPID-3), distance traveled and out-of-pocket costs, and patient satisfaction instruments. Similar data were compiled on a convenience sample of concurrent patients with inflammatory arthritis who were receiving usual care.
A total of 85 patients were followed, including 25 who received telemedicine care and 60 who were receiving usual care. No differences in demographics, satisfaction scores, or RAPID-3 scores were noted at baseline between the 2 groups.
According to univariate linear regression of cross-sectional baseline data, satisfaction instrument scores were predicted significantly by RAPID-3 (P =.01), as well as by distance from center of care (P =.02) and cost (P =.05). A multivariate model demonstrated that both distance and RAPID-3 scores were significant predictors of satisfaction with visit (P =.02 and P <.03, respectively).
Longitudinal follow-up indicated that mean distance traveled and visit costs were significantly reduced in the intervention group compared with the control group (P <.01 for both), but no statistically significant differences in RAPID-3 were noted at initiation of telemedicine follow-up (P =.89).
A major study limitation was the quantity of patient-year follow-up time and the small sample size, which precludes the measurement of many radiographic, mortality, and other long-term, more robust end points.
The investigators concluded that patient-centered factors such as distance to care should be considered in design care delivery models as they seem to drive patient satisfaction in combination with disease control.
Wood PR, Caplan L. Outcomes, satisfaction, and costs of a rheumatology telemedicine program: a longitudinal evaluation. J Clin Rheumatol. 2019;25(1):41-44.