Telemedicine Bridges Gaps in Patient Access to Rheumatologists

Telemedicine can improve healthcare access, patient outcomes, and costs, although it presents several potential obstacles. Expanded insurance coverage of this modality will be necessary to greater numbers of patients in need of specialty care.

Although it was previously considered a futuristic concept fraught with practical difficulties, the delivery of healthcare via telemedicine has now become quite common. It is especially popular in the realm of specialty care, including rheumatology, psychiatry, endocrinology, and more. For people who lack access to such care, this model can mean the difference between effective and inadequate treatment – or no treatment at all.

That is certainly the case in Pennsylvania, for example, where the University of Pittsburgh Medical Center (UPMC) has developed a robust telemedicine program now offering approximately 60 specialties to patients in various parts of the state. The program debuted in 2006 with stroke and psychiatry services, with rheumatology consultations being added in 2012.

Telerheumatology Reaches Patients with Limited or No Access

“We started offering telerheumatology because there are several geographical areas where there are UPMC facilities but no rheumatology services, and many patients had to drive several hours to come to Pittsburgh,” said Rohit Aggarwal, MD, MS, a rheumatologist, associate professor of medicine, and medical director of the Arthritis and Autoimmunity Center at UPMC. Such distance can lead many patients to stop seeing their rheumatologist, resulting in insufficient management of their disease. “There were delays in both diagnosis and treatment of patients, even those with severe rheumatological disorders,” he told Rheumatology Advisor.

Dr Aggarwal’s colleague, Christine Peoples, MD, a rheumatologist and clinical assistant professor of medicine at UPMC who conducts the most teleconsultations among the 133 UPMC telehealth providers, notes that an estimated 40% of patients in Pennsylvania who need to see a rheumatologist would end up not seeing one if telemedicine visits were not available. Instead, they can go to one of the UPMC facilities in the western and central parts of the state, where they can connect with one of the specialists at the university via videoconferencing.

“There is a shortage of rheumatologists, both in Pennsylvania and across the country. However, the need for rheumatology care is increasing,” Dr Peoples told Rheumatology Advisor. “Telemedicine represents a solution to provide the much-needed care to those patients who cannot travel 1 to 4 hours to see a rheumatologist. In addition, rheumatology patients have significant mobility issues due to their arthritis.”

In a new study of pediatric rheumatology patients at Children’s Mercy Hospital in Kansas City, Missouri, those who saw a doctor from a remote telemedicine outreach site cut their travel distance by nearly two-thirds, missed less time from work and school, and spent less money on food than they would have if they had traveled to the main site.1

Telerheumatology Can Improve Patient Outcomes

Not only does this modality improve access and convenience, it may also improve patient outcomes. In research published in BMC Musculoskeletal Disorders in April 2016, researchers compared 21 patients receiving intensive treatment via telemonitoring to 20 patients under conventional care.2 The results showed the telemedicine group had superior outcomes vs the conventional group in several areas: a higher percentage achieved remission at the 1-year mark (38.1% vs 25%, P <.01); median time to remission was 20 weeks vs more than 36 weeks for the conventional group; and they had greater improvements in functional impairment (71.4% vs 35%), radiological damage progression (23.8% vs 10%), and comprehensive disease control (19.4% vs 5%).

Dr Peoples sees a variety of patients via telemedicine, most commonly those with rheumatoid arthritis (RA), psoriatic arthritis (PA), osteoarthritis, severe gout, Sjogren’s syndrome, and systemic lupus erythematosus (SLE). She has had numerous patients for whom telemedicine was extremely helpful, including one with severe PA who had not been treated by a rheumatologist for a significant amount of time. Dr Peoples has now been treating the patient for almost 2 years. “He told me he now ‘has his life back’ and can play with his children,” she reported. “Another one of my patients went for years without a diagnosis for her symptoms and she now has the correct diagnosis, is on appropriate treatment, and is able to see and play with her new granddaughter.”

Dr Aggarwal, whose telemedicine patients most often include those with RA, Sjogren’s, and mild SLE, adds that they see all kinds of patients — except those needing only pain management or a specific joint injection. He describes a patient with severe RA who couldn’t travel out of town for rheumatology care. She “was being treated with steroids and nonsteroidal antiinflammatory drugs (NSAIDs), only leading to joint damage, whereas she needed disease-modifying antirheumatic drugs and a biological drug,” he said. “She significantly improved after starting methotrexate and the subsequently required biological drug, and she is now doing great with her rheumatoid arthritis in low disease activity.”