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

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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