Background/Purpose: Access to rheumatology care is becoming increasingly limited, necessitating a re-evaluation of patient pathways. The objective of this study was to evaluate a new patient pathway promoting patient empowerment, including remote patient monitoring (RPM) and asynchronous electronic visits (e-visits) in patients with rheumatoid arthritis (RA).

Methods: In this prospective, multi-center, randomized controlled trial performed at four German university outpatient services, adult patients with established RA and able to use a smartphone were included. Patients and rheumatologists used a tele-rheumatology platform to document and visualize the results of a self-performed quick CRP-test, self-performed joint count, and electronic patient-reported outcomes (ePROs) in between a baseline in-person visit (T0) and a three-month follow-up (T1). The treating rheumatologist recorded the treatment decision and patients recorded their therapeutic preference. Two independent randomized tele- rheumatologists from different university centers were given access to this information and the medical history via the tele-rheumatology platform. Based on this information they determined a remote asynchronous treatment decision (escalate, maintain, deescalate). The primary outcome was treatment concordance of in-person and tele-rheumatologists. Concordance of patients’ preferences and rheumatologists’ treatment decisions was assessed. Likelihood of patients to recommend e-visits to other patients was investigated using the net promoter score (NPS).

Results: 115 consecutive RA patients were recruited between August 12th 2021 and November 27th 2023 of which 114 patients were included in the analysis presented. 92/114 (80.7%) were female, mean age was 51.6 years and mean disease duration was 8.6 years, see table 1. Overall treatment concordance of F2F- and tele-rheumatologists was 72.9%, see Fig. 1A. 12.3% of discordant decisions represented deviations of maintaining / deescalating treatment. Concordance was highest for maintaining treatment regimen (85.2%), followed by treatment escalation (60.6%) and de-escalation (46.7%). Concordance between patient preference and in-person rheumatologists was 67.3%, see Fig. 1B. Concordance of tele-rheumatologists was 77.1%, see Fig. 1C. Patient recommendation rate of e-visits was mixed at T0 with a NPS of – 23.7% (promoters(9-10): 24.6%; detractors(1-6): 48.2%; mean ± SD 6.6 ± 2.5) and slightly increased at T1 with a NPS of -17.9% (promoters(9-10):27.4%; detractors(1-6): 45.3%; mean ± SD 6.2 ± 3.1).

Conclusion: TELERA is the first trial to investigate treatment decisions by asynchronous virtual visits compared to traditional in-person visits in rheumatology. The high treatment concordance observed in virtual visits, especially in stable patients where treatment can be maintained, demonstrates the feasibility and potential to alleviate rheumatology pressures. 

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/treatment-concordance-of-asynchronous-virtual-visits-compared-to-traditional-in-person-visits-in-patients-with-rheumatoid-arthritis-results-of-the-prospective-multi-center-randomized-controlled-tel/