medwireNews: Findings from two studies suggest that telemedicine is acceptable to people with rheumatic and musculoskeletal diseases (RMDs), may improve access to care for those living in resource-limited settings, and is not associated with worse disease activity outcomes.
In the first, Vir Singh Negi and colleagues from the Jawaharlal Institute of Postgraduate Medical Education and Research in Puducherry, India, evaluated the experiences of 373 non-biologic-treated RMD patients who took part in a remote consultation during the initial phase of the COVID-19 pandemic in April 2020. The majority of these people had a diagnosis of systemic lupus erythematosus (53.1%), with inflammatory arthritis the next most common diagnosis (21.7%).
In all, 89.6% of patients said they found their telemedicine consultation easy to follow, and 76.1% felt that remote appointments were better than in-person attendance given the circumstances. During the first month of the national lockdown, 68.6% of participants continued to take their prescribed medication, but 31.4% stopped treatment abruptly, primarily due to a worsening financial situation or lack of public transport.
Negi et al note that the vast majority (93%) of participants had a monthly median household income of less than INR 14,000 (US$ 182; € 156) before COVID-19. They found that individuals whose financial needs were adequately met were significantly less likely to discontinue treatment than those with unmet needs, at an odds ratio of 0.38.
Using a modeling approach, the team estimated that 47.2% of the 289 patients who were in remission or had low disease activity on a stable dose of DMARDs could potentially save money by acquiring their treatment at a local pharmacy rather than visiting the hospital. Moreover, they estimated that all 289 of these people (77.4% of the total cohort) could be successfully switched to remote follow-up if drugs were made available at their closest state-run secondary care government hospital.
“The pandemic has had massive economic implications on the families of patients suffering from rheumatic diseases,” and “[s]witching to a telemedicine-based hybrid model is likely to improve drug adherence with substantial savings,” conclude Negi and team in Rheumatology.
In the second study, Wieland Müskens (Radboud University Medical Center, Nijmegen, the Netherlands) and colleagues compared the number of clinic visits and DAS28 scores in patients with rheumatoid arthritis before and after the introduction of a telemedicine platform in 2017.
They report in Rheumatology Advances in Practice that 38% of 1145 eligible patients were active users of the platform – which enables self-monitoring of disease activity and allows patients and healthcare providers to communicate through messages – by 2019. The average number of quarterly outpatient clinic visits decreased significantly by 0.027 per quarter after introduction of the platform, and DAS28 scores decreased by an average of 0.056 points per quarter.
These findings suggest that “[t]he implementation of remote patient monitoring has a positive effect on healthcare utilization, while maintaining low disease activity,” say Müskens and colleagues.
The researchers note, however, that telemedicine users on average were younger, more highly educated, and had better health outcomes than those who did not use the platform, and “[t]his selective use of telemedicine, where eHealth is least used by the people who need it most, risks to widen the gap between those at risk of Social Health Inequalities and the rest of the population.”
They caution that “healthcare professionals need to remain vigilant to ensure that those currently unable to participate in telemedicine receive the care they need.”
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group
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Rheumatology 2020; doi:10.1093/rheumatology/keaa791
Rheumatol Adv Pract 2021; doi:10.1093/rap/rkaa079