Background/Purpose:

Access to a rheumatologist and frequent monitoring of disease activity in rheumatoid arthritis (RA) are associated with higher quality of care and improved outcomes. With the current rheumatology workforce shortage in the US and concentration of rheumatologists in urban areas, there is a need for strategies addressing barriers to access. Telemedicine video consultation has been implemented within the Alaska Tribal Health System specialty clinics, including rheumatology. The purpose of this study is to evaluate the impact of telemedicine follow-up for RA on disease activity, quality of care, and access to care and to investigate patient perceptions of telemedicine. This analysis describes the baseline characteristics and perceptions of enrolled study participants.

Methods: Study participants with a diagnosis of RA were recruited when seeing a rheumatologist, either in-person or by telemedicine. At the study visit, participants completed the RAPID3 and a telemedicine survey and agreed to medical record review for demographics, disease characteristics, and measures of quality and access to care. Participants also agreed to telephone contact at 6 and 12 months for follow-up surveys and RAPID3. For data analysis, participants are categorized as being in the telemedicine group if they have had at least one telemedicine visit with a rheumatologist and in the in-person group otherwise.

Results: To date, 65 participants have enrolled in the study (25 telemedicine and 40 in-person). Age, sex, disease duration, and baseline RAPID3 score were similar across groups. The telemedicine group had a higher mean number of rheumatologist visits in the past year (3.3 vs. 2.3, p=0.002). Both groups expressed a preference of seeing a specialist in-person rather than by video and the opinion that it is important for the specialist to physically examine them. However, those seen by telemedicine were more likely to consider telemedicine an acceptable way to receive health services (p=0.008) and to have favorable opinions about other aspects of telemedicine, including respect for culture (p=0.002), patient involvement in decision-making (p<0.001), ability to talk easily and openly to provider (p<0.001), and trusting the equipment to work (p=0.04). Finally, those seen by telemedicine were more likely to consider the care given in video visits to be as good as in-person visits (p<0.001).

Conclusion:

Telemedicine can improve access to care in patients with RA. Although patients in both groups expressed a preference for in-person visits, those seen by telemedicine were more likely to have favorable opinions of it. Whether telemedicine can improve quality of care and disease activity is not yet known.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/telemedicine-for-rheumatoid-arthritis-in-the-alaska-native-population/