Recommendations on Telemedicine in Rheumatology Save

The integration of Telemedicine in to rheumatologic care was ignited by pandemic restrictions in early 2020 and since the advantages and disadvantages have been debated. Disadvantages included limitations based on technology (especially in older and non-priviledged groups), exam assessments and patient communications.  The advantages of telehealth are numerous, including patient safety, travel and mobility limitations, expediency, cost and convenience.

Numerous groups, societies and regulatory bodies have grappled with potential guidelines for telemedicien use.  Recently, the Asia Pacific League of Associations for Rheumatology (APLAR) has developed evidence-based recommendations for rheumatology practice to guide and maintain high standards to clinical care. 

Three overarching principles and 13 recommendations were developed based on literature review and consensus agreement.

Overarching Principles

• Telemedicine in rheumatology should use a framework that assesses all components - patient perspective, efficacy, safety, economnics, ethics, etc.
• Shared decision-making is paramount
• Telemedicine should be appropriate to the patient, diagnosis, disease activity, setting, technology, etc..

Recommendations for Use

1. All patients should be assessed for telemedicine (TM) and be offered TM over < 12 mos.
2. New, undiagnosed patients should best be seen in-person, but TM may provide preliminary guidance to the patient and referring physician
3. Pre-telemedicine triage  of patients may better identify those apt to benefit from TM
4. When health services are disrupted, TM is preferred over unsupervised medication changes or management.
5. Televideo consultation is preferred over other modalities (phone, email, etc) conditionally
6. In person consultation is recommended when TM yields uncertainty or problems with communication
7. TM consultations are preferred when there is a health care professional on hand for the MSK examination
8. Patient data, privacy and integrity must be protectedd
9. Use of patient reported outcomes (PRO's) are to be encouraged
10. Treat to target management should be used in TM as it is used with in person care.
11. Rheums practicing TM should be acquainted with the process and technology used for TM
12. TM may also be used in the training of health care workers and advanced practice providers
13. TM platforms should be developed to assist patient education

As the use of telemedicine care in rheumatology is limited and evolving, these recommendations will benefit from further evaluation and study. 

Another recent publication examined at Outcomes in rheumatoid arthritis care, with or without video Telemedicine follow-up visits.

A 12 month outcome assessment of 122 RA patients in the Alaska Tribal Health System - 52% had ever used telemedicine for RA (48% not). In multivariate analysis, RAPID3 score and functional status were higher with telemedicine group, with no statistically significant change over the 12-month period.  Disease activity was more likely to be assessed in the in-person group vs. TM group (40% versus 25%; P = 0.02), but this was not significant after multivariate analysis.

Overall, with 12 months of follow-up, there was no significant difference in most outcome and quality measures in patients with RA who incorporated telemedicine follow-up in their care compared to in-person only.