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Abstract Number: 1448

Virtual Visits versus Face-to-Face Visits for Rheumatoid Arthritis (RA): Comparison of Treat to Target (TTT) Adherence in 18 US Rheumatology Practices

DH Solomon1, Nancy Shadick1, Theodore Pincus2, Josef Smolen3, Jack Ellrodt1, Jacklyn Stratton1, Leah Santacroce1, Jeffrey Katz1, Prem Chatpar4, Mary Stocks4, Breanna Mundell4, Christina Downey5, Karina Torralba6, Douglas White7, Meggan Baudek7, Steven Szlembarski7, Sharon Barnhart7, Jawad Bilal8, Albert Redford8, Dylan Lee8, Julia Buchfuhrer9, Helene Kramer8, C. Kent Kwoh10, Michel Villatoro-Villar8, Asha Patnaik11, Edgardo Guzman11, Rebecca Trachtman12, John Tesser13, Dijana Music14, Lexi Mickey15, Mona Amin16, Jeffrey Potter17, Joshua Sundhar18, Jessica Sheingold19, Juan Schmukler20, Diane Horowitz21, Hannah Gulko21, Robert Quinet22, Swathi Dhulipala23, Ronak Patel24, Chandana Keshavamurthy25, Guiset Carvajal Bedoya26, Rhonda Dunn27, Bharat Kumar27, Aleksander Lenert27, Hanna Zembrzuska27 Matthew Gebre28, Petar Lenert29, Allen Anandarjah30, Annie Yang30, Linda Grinnell-Merrick30, Shadefai Goldsmith30, Jonna Zelie30, Leanna Wise31, Nicole Zagelbaum Ward32 and Jeffrey Kaine33 1Brigham and Women's Hospital, Boston, MA, 2Rush University Medical Center, Chicago, IL, 3University of Vienna, Vienna, Austria, 4Dr. Chatpar and Associates, LLC, Plainview, NY, 5Loma Linda University Medical Center, Redlands, CA, 6Division of Rheumatology, Department of Medicine, Loma Linda University Healthcare, Loma Linda, CA, 7Gundersen Health, La Crosse, WI, 8University of Arizona, Phoenix, AZ, 9University of Arizona, Pheonix, AZ, 10University of Arizona College of Medicine, Tuscon, AZ, 11Stony Brook School of Medicine, Stony Brook, NY, 12Icahn School of Medicine at Mount Sinai, New York, NY, 13Arizona Arthritis & Rheumatology Associates, P.C., Phoenix, AZ, 14Arizona Arthritis and Rheumatology Associates, Glendale, AZ, 15Arthritis and Rheumatology Associates- Glendale, Glendale, AZ, 16Arthritis and Rheumatology Associates- Phoenix, Phoenix, AZ, 17Arthritis & Rheumatism Associates, Wheaton, MD, 18Arthritis Rheum & Back Disease Assoc., Voorhees, NJ, 19MedStar Georgetown University Hospital, Washington, DC, 20Mount Sinai- Chicago, Chicago, IL, 21Northwell Health, Great Neck, NY, 22Ochsner Health, River Ridge, LA, 23Ochsner Clinic Foundation, River Ridge, LA, 24Ochsner Health, Jefferson, LA, 25Ochsner, New Orleans, LA, 26University of Colorado, aurora, CO, 27University of Iowa, Iowa City, IA, 28Loma Linda University Medical Center, Loma Linda, CA, 29University of Iowa Medical School, Iowa City, IA, 30University of Rochester, Rochester, NY, 31LAC+USC/Keck Medicine of USC, Pasadena, CA, 32LAC+USC Medical Center, Los Angeles, CA, 33Cullowhee, NC

Meeting: ACR Convergence 2021

Keywords: quality of care, rheumatoid arthritis

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Session Information

Date: Monday, November 8, 2021

Title: Abstracts: Clinical Epidemiology (1446–1451)

Session Type: Abstract Session

Session Time: 2:30PM-2:45PM

Background/Purpose: TTT is the recommended paradigm for managing RA according to major rheumatology organizations, however the literature suggests that TTT has not been widely implemented in US rheumatology. In a prior randomized controlled trial, we found that a learning collaborative (LC) was effective for improving implementation of TTT. (1) During the current study, we worked with US rheumatology practices on implementing TTT during 2020-2021 when some visits were conducted face-to-face (F2F) and other visits virtually (VV). These analyses examine differences in adherence with TTT based on whether the visit was F2F or VV.

Methods: During 2020-2021, we conducted a virtual Learning Collaborative (LC) for TTT in RA. 18 US-based rheumatology practices and 45 clinicians (MD, DO, NP, PA, RN) were engaged in the LC. The LC was 6 months in duration and each month the practices abstracted data from 20-25 visits with RA patients, focusing on adherence with TTT. Adherence was measured as a percentage of TTT component processes: 1) measure and document disease activity (any standard measure was acceptable), 2) determine a target disease activity, 3) make treatment changes if not at target, and 4) document shared decision-making. We then analyzed TTT adherence overall and by visit type, comparing F2F with VV. Further, VV visits were stratified as telephone or video.

Results: The 18 sites were distributed widely across the US, representing 10 states plus Washington DC, and their locations varied in COVID pandemic policies. During the 6 months, sites entered data on 1826 patient visits: 78% were F2F and 22% were VV. Overall adherence with TTT during the six months improved from a mean of 51% to 84%. Each component process of TTT was compared between F2F and VV visits (see Table 1). Over the full follow-up of the LC, there was greater adherence with TTT when visits were F2F (79% adherence) versus VV (65% adherence) (p < 0.0001). Documentation of a disease activity measure, a target, and change in treatment if not at target were all more common in the F2F versus VV visits (all p < 0.05). Documentation of shared decision making was similar across the two types of visits. F2F adherence started at 67% whereas VV was 43% (p < 0.0001). However, by the last month, F2F was at 85% and VV at 76% (p = 0.059) (see Figure 1). Of the VV, 43% were conducted by telephone and 57% by video. Comparing overall adherence with TTT across these two types of VVs, there was not difference in overall adherence between video visits and telephone visits, 64.8% and 65.3%, respectively.

Conclusion: Implementing TTT for RA is a challenge, especially during the COVID pandemic. Among 18 US rheumatology practices engaged in implementing TTT, we found that adherence with TTT was slightly worse for VV compared with F2F. However, adherence with TTT improved for both types of patient visits, even during the COVID19 pandemic, and was similar after a six-month learning collaborative.

1. Solomon, D. H., et al. Implementation of Treat-to-Target in Rheumatoid Arthritis Through a Learning Collaborative: Results of a Randomized Controlled Trial. Arthritis Rheumatol 2017;69:1374-1380.


Disclosures: D. Solomon, Abbvie, 5, Amgen, 5, Genentech, 5; N. Shadick, BMS, 5, Mallinckrodt, 5, Sanofi/Regeneron, 5, Crescendo Biosciences, 5; T. Pincus, Medical History Services LLC, 8, 9, 10, 12; J. Smolen, Abbvie, 5, 6; J. Ellrodt, None; J. Stratton, None; L. Santacroce, None; J. Katz, Samumed, 5; P. Chatpar, None; M. Stocks, None; B. Mundell, None; C. Downey, None; K. Torralba, GlaxoSmithKline, 12, Clinical Trials Support, UCB, 2, Exagen, 2, Aurinia Pharmaceuticals, 2, Ultrasound School of North American Rheumatologists (SUSONAR) Southern California Rheumatology Society (SCRS), 4, Janssen, 12, Support for educational programs, Radius Health, 12, Support for educational programs, Amgen, 12, Support for educational programs, Novartis, 2, 12, Clinical Trials Support, Pfizer, 12, Support for educational programs, AstraZeneca, 12, Clinical Trials Support; D. White, None; M. Baudek, None; S. Szlembarski, None; S. Barnhart, None; J. Bilal, None; A. Redford, None; D. Lee, None; J. Buchfuhrer, None; H. Kramer, None; C. Kwoh, Lilly, 5, Abbvie, 5, Kolon Tissue Gene, 12, DSMB, Regeneron, 1, LG Chem, 1; M. Villatoro-Villar, None; A. Patnaik, None; E. Guzman, None; R. Trachtman, None; J. Tesser, Bristol-Myers Squibb, 1, 2, 5, 6, Janssen, 1, 2, 5, 6, Eli Lily, 1, 2, 5, 6, Pfizer, 1, 2, 5, 6, AbbVie, 1, 2, 5, 6, Astra Zeneca, 1, 2, 6, GlaxcoSmithKline, 6, Amgen, 5, 6, Boehringer Ingelheim, 5, Genentech, 5, Horizon Therapeutics plc, 5, SunPharma, 5, Gilead, 2, 5, Novartis, 2, 5, Celgene, 5, Merck KG, 5, Sandoz, 5, Setpoint, 5, UCB Pharma, 5, Crescendo Biosciences/Myriad, 6, Sanofi-Genzyme, 1, 2, 6, Aurinia, 1, 2, 6, Samumed/Biosplice, 1, 2, 5, Vorso, 5, Selecta, 5, Exagen, 5, CSL Behring, 5, Organogenesis, 5, D R L Pharma, 5, Emerald Health, 5; D. Music, None; L. Mickey, None; M. Amin, Horizon, 6, Lilly, 6; J. Potter, None; J. Sundhar, Abbvie, 6, Amgen, 6, Sanofi, 6, novartis, 6, pfizer, 6, medac, 6; J. Sheingold, None; J. Schmukler, None; D. Horowitz, None; H. Gulko, None; R. Quinet, None; S. Dhulipala, None; R. Patel, None; C. Keshavamurthy, None; G. Carvajal Bedoya, None; R. Dunn, None; B. Kumar, None; A. Lenert, None; H. Zembrzuska, None; M. Gebre, None; P. Lenert, None; A. Anandarjah, None; A. Yang, None; L. Grinnell-Merrick, Abbvie, 2, 6, Amgen, 2, 6, Novartis, 2, 6, Sanofie/Regeneron, 2, 6, Janssen, 2, 6, UCB, 2, Avion, 2, 6, Pfizzer, 2, Celegene, 2, 6, Novartis, 12, As of April 26, 2021 I am a full time employee of Novartis, I continue to work per diem at the Universtiy of Rochester Dept of Allergy, Immunology and Rheumatology; S. Goldsmith, None; J. Zelie, None; L. Wise, None; N. Zagelbaum Ward, None; J. Kaine, Sanofi-Genzyme, 3, 7.

To cite this abstract in AMA style:

Solomon D, Shadick N, Pincus T, Smolen J, Ellrodt J, Stratton J, Santacroce L, Katz J, Chatpar P, Stocks M, Mundell B, Downey C, Torralba K, White D, Baudek M, Szlembarski S, Barnhart S, Bilal J, Redford A, Lee D, Buchfuhrer J, Kramer H, Kwoh C, Villatoro-Villar M, Patnaik A, Guzman E, Trachtman R, Tesser J, Music D, Mickey L, Amin M, Potter J, Sundhar J, Sheingold J, Schmukler J, Horowitz D, Gulko H, Quinet R, Dhulipala S, Patel R, Keshavamurthy C, Carvajal Bedoya G, Dunn R, Kumar B, Lenert A, Zembrzuska H, Gebre M, Lenert P, Anandarjah A, Yang A, Grinnell-Merrick L, Goldsmith S, Zelie J, Wise L, Zagelbaum Ward N, Kaine J. Virtual Visits versus Face-to-Face Visits for Rheumatoid Arthritis (RA): Comparison of Treat to Target (TTT) Adherence in 18 US Rheumatology Practices [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/virtual-visits-versus-face-to-face-visits-for-rheumatoid-arthritis-ra-comparison-of-treat-to-target-ttt-adherence-in-18-us-rheumatology-practices/. Accessed .
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