Background/Purpose: In Australia there is a nationwide rheumatologist shortage potentially translating to poorer clinical outcomes for those living with rheumatic diseases. ¹ A possible solution to improve patient care in this setting is telemedicine (TM). During the COVID-19 pandemic TM consultations increased significantly resulting in an opportunity to review rheumatologists’ use of TM. The aim of this study was to examine the utilisation and provider perceptions of TM in rheumatology. This study investigated the usage of TM by rheumatologists before and during the COVID-19 pandemic and explored the models of care utilised and the challenges experienced.

Methods: A sequential mixed-methods study design was adopted and rheumatologists completed a questionnaire including demographics, clinical practice, TM uptake, models of care applied and clinician perceptions of TM. The qualitative phase utilised purposeful sampling of active users of TM through in-depth semi-structured interviews. The impact of COVID 19 pandemic on TM use for rheumatology practise was explored.

Results: Thirty Queensland rheumatologists participated in surveys with 76.7% actively utilising TM. Usage of TM was limited prior to the COVID-19 with 9.5% seeing more than 5 patients per week. Patient populations served by TM included capital city (n=16, 53.3%), regional (n=19, 63.3%) and rural/remote (n=7, 23.3 %). A significant association between rheumatologists (n=29) having ever practised in a rural/remote setting (n=19, 65.5%) and use of TM within the last 24 months (n=17, 58.62%), p=0.030 was seen with no association found for formal training in TM or years of experience as a rheumatologist and TM usage. Of the active TM users prior to the COVID-19 pandemic 90% commenced conventional DMARDs and 55% biological DMARDS through TM. One of the major barriers to wider usage included low to medium confidence with joints assessments through TM (n= 15/19). Qualitative analysis further identified barriers to TM uptake including limited distribution of technology, administrative and peripheral clinical staff involvement and lack of financial incentives particularly in the private sector. During the COVID-19 pandemic, a significant expansion of TM as telephone calls occurred with rheumatologists reporting low confidence and satisfaction with this, whilst identifying that telephone calls and TM may be an acceptable model for monitoring stable patients with low disease activity.

Conclusion: Familiarity with TM exists in this rheumatology cohort, however its usage in routine practise is limited due to multiple barriers. The COVID 19 pandemic highlighted lower confidence in telephone calls as a form of TM and concerns regarding new or unstable patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-telemedicine-for-rheumatology-practice-in-queensland-australia-experiences-before-and-during-the-covid-19-pandemic/