Patients with rheumatic diseases can benefit from telemedicine

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A systemic review found that patients with rheumatic diseases experienced comparable outcomes and satisfaction with telemedicine compared to in-person treatment.

According to a study published in Seminars on arthritis and rheumatism.

The COVID-19 pandemic has spurred a sudden adoption of telemedicine in rheumatology. Telemedicine can reduce costs and increase accessibility, while providing comparable patient outcomes compared to in-person appointments. However, the researchers in the current study encourage further investigation to determine the best uses of telemedicine for rheumatic conditions.

“This unprecedented and rapid transition to virtual methods of consultation and follow-up in rheumatology in the wake of the COVID-19 pandemic has presented unique challenges in the management of patients with RMD,” the authors wrote.

They analyzed the recent literature on telemedicine for the diagnosis and management of inflammatory, non-inflammatory and/or autoimmune rheumatic diseases. A systemic registered search of interventional or observational studies published between August 2015 and January 2022 was performed, and studies were included if they reported results in 10 or more people with rheumatic disease.

Thirty-six reports met the inclusion criteria: 27 observational studies, 7 randomized clinical trials and 2 controlled clinical trials. These studies involved 7102 patients with various rheumatic conditions; however, sample sizes were small in the majority of these studies.

These studies included general rheumatology, rheumatoid arthritis, gout, osteoarthritis, unspecified inflammatory arthritis, osteoporosis, and systemic lupus erythematosus. The researchers included patients with non-inflammatory diseases because they represent a unique patient population particularly suited to remote disease monitoring.

The resulting analysis demonstrated that the most commonly reported outcome was patient satisfaction, as the majority of studies demonstrated high levels of satisfaction.

The effect of telemedicine on the primary outcomes varied across intervention studies. Most found telemedicine to be as good as usual/in-person care for controlling disease activity, patient satisfaction, total societal costs, and other patient-reported outcomes . Additionally, efficacy and feasibility were found to be high for all types of telemedicine interventions based on several factors including disease activity, satisfaction, and cost-effectiveness. The study investigators, however, noted that most were at high risk of bias.

Costing data, conducted in 7 of the studies, indicated that telemedicine generally provided cost savings compared to in-person visits, with travel savings being the largest.

These results demonstrate that telemedicine can be an effective mode of care delivery for inflammatory, non-inflammatory, and autoimmune rheumatic diseases.

The authors suggest that telemedicine has the potential to ease barriers to care and address workforce shortages in rheumatology, though they caution that physicians should be aware of digital literacy disparities when are considering telemedicine options for patients.

Although this review highlights unmet needs in rheumatology, the authors encourage further research. Specifically, they recommend randomized clinical trials to determine the best uses of telemedicine for the diagnosis and management of rheumatic conditions and its effect on clinical outcomes.

Most of the studies showed limitations due to their design and overall high risk of bias. In addition, many observational studies lacked a comparison group.

The authors note that their findings regarding the effectiveness of telemedicine should be interpreted with caution given the small sample sizes and inability to blind participants.

However, they claim that even studies showing moderate or high bias can still be meaningful and contribute to the telemedicine and rheumatology literature.

Reference

Jackson LE, Edgil TA, Hill B, et al. Telemedicine in rheumatology care: a systematic review. Semin Arthritis Rheum. Published online June 15, 2022. doi:10.1016/j.semarthrit.2022.152045

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