Background/Purpose: Rural Veterans with inflammatory arthritis (IA) lack access because of geographic and other barriers. A national shortage of rheumatologists exists, particularly in rural settings, and recent data suggest rural IA patients have poorer outcomes than those in close proximity to large cities and tertiary care. Synchronous Telemedicine (TM) is an emerging care delivery modality which has been employed in a variety of disease settings which holds great promise in relieving some of these disparities. Limited program evaluation of TM in rheumatologic care has been conducted, including examination of specialty-specific and patient centered outcomes, quality of care, patient satisfaction, or cost-effectiveness longitudinally for care delivered in this fashion.

Methods: Veterans with IA (including crystalline, rheumatoid arthritis (RA), and spondyloarthritis) in a widely disbursed VA health care system were enrolled in periodic TM follow-up. Data were collected longitudinally before and after entering the program, including patient-centered outcomes (e.g. RAPID3), and select patient satisfaction instruments adapted from the Survey of Health Experience for Patients (SHEP). Demographics were recorded. Similar data were collected on a convenience sample of concurrent IA patients enrolled in usual care (UC) clinics. Descriptive statistics, linear regression, and t-tests were performed.

Results: 60 patients were observed, including 19 in an initial TM cohort, and 41 UC patients. Mean age was 64.2, 90% were male, and 70% carried a clinical diagnosis of RA. No differences in these demographics were noted between groups. RAPID3 scores did not vary between TM and UC groups at baseline, with mean scores of approximately 11 (moderately active). Multiple SHEP instrument scores varied between groups initially (e.g. 8.3 vs 5.7 on a 1-10 Likert scale, p<0.01) and the TM cohort initially travelled greater distance (459.4mi vs 86.9mi, p<0.01) and spent more money ($157.72 vs $40.27, p<0.01) per visit than UC patients. Multivariate regression analyses suggest SHEP scores were predicted by disease activity status (β=-0.10, p=0.04) only when also accounting for additional patient-centered factors including cost (β= 0.01, p<0.01) and distance (β= -0.01, p<0.01). In longitudinal follow-up via TM, SHEP instrument scores improved significantly among TM patients (β=3.54, p<0.01). Distance travelled (-454.4mi/visit, p<0.01) and costs ($-134.78/visit, p<0.01) were also significantly reduced in this group, with no significant changes in RAPID3 observed.

Conclusion: Synchronous TM may be a viable alternative to routine follow-up for IA care in rural settings and represents a radical change towards patient-centered care paradigms. Long-term follow-up and additional study including outcomes validation in TM care in rheumatology are warranted.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/synchronous-telemedicine-care-in-rheumatology-for-a-dispersed-veterans-affairs-health-system/