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Novella-Navarro M, Iniesta-Chamorro JM, Benavent D, Bachiller-Corral J, Calvo-Aranda E, Borrell H, Berbel-Arcobé L, Navarro-Compan V, Michelena X, Lojo-Oliveira L, Arroyo-Palomo J, Diaz-Almiron M, García García V, Monjo-Henry I, Gómez González CM, Gomez EJ, Balsa A, Plasencia-Rodríguez C. Toward Telemonitoring in Immune-Mediated Inflammatory Diseases: Protocol for a Mixed Attention Model Study. JMIR Res Protoc 2024; 13:e55829. [PMID: 38501508 PMCID: PMC11074894 DOI: 10.2196/55829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Rheumatic and musculoskeletal diseases (RMDs) are chronic diseases that may alternate between asymptomatic periods and flares. These conditions require complex treatments and close monitoring by rheumatologists to mitigate their effects and improve the patient's quality of life. Often, delays in outpatient consultations or the patient's difficulties in keeping appointments make such close follow-up challenging. For this reason, it is very important to have open communication between patients and health professionals. In this context, implementing telemonitoring in the field of rheumatology has great potential, as it can facilitate the close monitoring of patients with RMDs. The use of these tools helps patients self-manage certain aspects of their disease. This could result in fewer visits to emergency departments and consultations, as well as enable better therapeutic compliance and identification of issues that would otherwise go unnoticed. OBJECTIVE The main objective of this study is to evaluate the implementation of a hybrid care model called the mixed attention model (MAM) in clinical practice and determine whether its implementation improves clinical outcomes compared to conventional follow-up. METHODS This is a multicenter prospective observational study involving 360 patients with rheumatoid arthritis (RA) and spondylarthritis (SpA) from 5 Spanish hospitals. The patients will be followed up by the MAM protocol, which is a care model that incorporates a digital tool consisting of a mobile app that patients can use at home and professionals can review asynchronously to detect incidents and follow patients' clinical evolution between face-to-face visits. Another group of patients, whose follow-up will be conducted in accordance with a traditional face-to-face care model, will be assessed as the control group. Sociodemographic characteristics, treatments, laboratory parameters, assessment of tender and swollen joints, visual analog scale for pain, and electronic patient-reported outcome (ePRO) reports will be collected for all participants. In the MAM group, these items will be self-assessed via both the mobile app and during face-to-face visits with the rheumatologist, who will do the same for patients included in the traditional care model. The patients will be able to report any incidence related to their disease or treatment through the mobile app. RESULTS Participant recruitment began in March 2024 and will continue until December 2024. The follow-up period will be extended by 12 months for all patients. Data collection and analysis are scheduled for completion in December 2025. CONCLUSIONS This paper aims to provide a detailed description of the development and implementation of a digital solution, specifically an MAM. The goal is to achieve significant economic and psychosocial impact within our health care system by enhancing control over RMDs. TRIAL REGISTRATION ClinicalTrials.gov NCT06273306; https://clinicaltrials.gov/ct2/show/NCT06273306. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55829.
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Affiliation(s)
| | - Jose M Iniesta-Chamorro
- Biomedical Engineering and Telemedicine Centre, Center for Biomedical Technology, Escuela Tecnica Superior de Ingenieros de Telecomunicacion, Universidad Politecnica de Madrid, Madrid, Spain
| | - Diego Benavent
- Rheumatolgy Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | | | | | | | | | | | | | | | - Jaime Arroyo-Palomo
- Rheumatology Department, Hospital Universitario Ramon y Cajal, Madrid, Spain
| | | | | | - Irene Monjo-Henry
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Enrique J Gomez
- Biomedical Engineering and Telemedicine Centre, Center for Biomedical Technology, Escuela Tecnica Superior de Ingenieros de Telecomunicacion, Universidad Politecnica de Madrid, Madrid, Spain
- Centro De Investigación Biomédica En Red De Bioingeniería, Biomateriales Y Nanomedicina, Madrid, Spain
| | - Alejandro Balsa
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
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Accorsi TAD, dos Santos GGR, Nemoto RP, Moreira FT, De Amicis K, Köhler KF, Cordioli E, Pedrotti CHS. Telemedicine and patients with heart failure: evidence and unresolved issues. EINSTEIN-SAO PAULO 2024; 22:eRW0393. [PMID: 38451690 PMCID: PMC10948100 DOI: 10.31744/einstein_journal/2024rw0393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 10/26/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Heart failure is the leading cause of cardiac-related hospitalizations. Limited access to reevaluations and outpatient appointments restricts the application of modern therapies. Telemedicine has become an essential resource in the healthcare system because of its countless benefits, such as higher and more frequent appointments and faster titration of medications. This narrative review aimed to demonstrate the evidence and unresolved issues related to the use of telemedicine in patients with heart failure. No studies have examined heart failure prevention; however, several studies have addressed the prevention of decompensation with positive results. Telemedicine can be used to evaluate all patients with heart failure, and many telemedicine platforms are available. Several strategies, including both noninvasive (phone calls, weight measurement, and virtual visits) and invasive (implantable pulmonary artery catheters) strategies can be implemented. Given these benefits, telemedicine is highly desirable, particularly for vulnerable groups. Although some questions remain unanswered, the development of new technologies can complement remote visits and improve patient care.
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Affiliation(s)
| | | | - Renato Paladino Nemoto
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Flavio Tocci Moreira
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karine De Amicis
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Karen Francine Köhler
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Eduardo Cordioli
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Howe C, Smith ID, Coles TM, Overton R, Economou-Zavlanos N, Solomon MJ, Doss J, Henao R, Clowse MEB, Leverenz DL. Evaluating Provider Perceptions of Telehealth Utility in Outpatient Rheumatology Telehealth Encounters. J Clin Rheumatol 2024; 30:46-51. [PMID: 38169348 DOI: 10.1097/rhu.0000000000002050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE This study aims to explore the factors associated with rheumatology providers' perceptions of telehealth utility in real-world telehealth encounters. METHODS From September 14, 2020 to January 31, 2021, 6 providers at an academic medical center rated their telehealth visits according to perceived utility in making treatment decisions using the following Telehealth Utility Score (TUS) (1 = very low utility to 5 = very high utility). Modified Poisson regression models were used to assess the association between TUS scores and encounter diagnoses, disease activity measures, and immunomodulatory therapy changes during the encounter. RESULTS A total of 481 telehealth encounters were examined, of which 191 (39.7%) were rated as "low telehealth utility" (TUS 1-3) and 290 (60.3%) were rated as "high telehealth utility" (TUS 4-5). Encounters with a diagnosis of inflammatory arthritis were significantly less likely to be rated as high telehealth utility (adjusted relative risk [aRR], 0.8061; p = 0.004), especially in those with a concurrent noninflammatory musculoskeletal diagnosis (aRR, 0.54; p = 0.006). Other factors significantly associated with low telehealth utility included higher disease activity according to current and prior RAPID3 scores (aRR, 0.87 and aRR, 0.89, respectively; p < 0.001) and provider global scores (aRR, 0.83; p < 0.001), as well as an increase in immunomodulatory therapy (aRR, 0.70; p = 0.015). CONCLUSIONS Provider perceptions of telehealth utility in real-world encounters are significantly associated with patient diagnoses, current and prior disease activity, and the need for changes in immunomodulatory therapy. These findings inform efforts to optimize the appropriate utilization of telehealth in rheumatology.
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Affiliation(s)
| | | | - Theresa M Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | | | | | | | - Jayanth Doss
- Division of Rheumatology and Immunology, Department of Medicine
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Creagh AP, Hamy V, Yuan H, Mertes G, Tomlinson R, Chen WH, Williams R, Llop C, Yee C, Duh MS, Doherty A, Garcia-Gancedo L, Clifton DA. Digital health technologies and machine learning augment patient reported outcomes to remotely characterise rheumatoid arthritis. NPJ Digit Med 2024; 7:33. [PMID: 38347090 PMCID: PMC10861520 DOI: 10.1038/s41746-024-01013-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
Digital measures of health status captured during daily life could greatly augment current in-clinic assessments for rheumatoid arthritis (RA), to enable better assessment of disease progression and impact. This work presents results from weaRAble-PRO, a 14-day observational study, which aimed to investigate how digital health technologies (DHT), such as smartphones and wearables, could augment patient reported outcomes (PRO) to determine RA status and severity in a study of 30 moderate-to-severe RA patients, compared to 30 matched healthy controls (HC). Sensor-based measures of health status, mobility, dexterity, fatigue, and other RA specific symptoms were extracted from daily iPhone guided tests (GT), as well as actigraphy and heart rate sensor data, which was passively recorded from patients' Apple smartwatch continuously over the study duration. We subsequently developed a machine learning (ML) framework to distinguish RA status and to estimate RA severity. It was found that daily wearable sensor-outcomes robustly distinguished RA from HC participants (F1, 0.807). Furthermore, by day 7 of the study (half-way), a sufficient volume of data had been collected to reliably capture the characteristics of RA participants. In addition, we observed that the detection of RA severity levels could be improved by augmenting standard patient reported outcomes with sensor-based features (F1, 0.833) in comparison to using PRO assessments alone (F1, 0.759), and that the combination of modalities could reliability measure continuous RA severity, as determined by the clinician-assessed RAPID-3 score at baseline (r2, 0.692; RMSE, 1.33). The ability to measure the impact of the disease during daily life-through objective and remote digital outcomes-paves the way forward to enable the development of more patient-centric and personalised measurements for use in RA clinical trials.
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Affiliation(s)
- Andrew P Creagh
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK.
- Big Data Institute, University of Oxford, Oxford, UK.
| | | | - Hang Yuan
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gert Mertes
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | | | | | | | - Aiden Doherty
- Big Data Institute, University of Oxford, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - David A Clifton
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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May S, Darkow R, Knitza J, Boy K, Schwarz J, Heinze M, Hornig J, Aries P, Welcker M, Muehlensiepen F. "The Simpler, the Better." A Qualitative Study on Digital Health Transformation in Early Adopter Rheumatology Outpatient Clinics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241247021. [PMID: 38801153 PMCID: PMC11131398 DOI: 10.1177/00469580241247021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 05/29/2024]
Abstract
Workforce shortage and the increasing burden of rheumatic and musculoskeletal diseases lead to extreme time constraints in rheumatology outpatient care. Digital services promise to facilitate care by relieving employees and unleash new capacities. This study aims to explore the perspectives of early adopter health care professionals (HCP) on digital transformation in outpatient rheumatology. In-depth qualitative interviews were conducted with rheumatology nurses and physicians in 3 German rheumatology outpatient clinics, each characterized by an advanced level of digital adaption. Qualitative data were subsequently analyzed using deductive-inductive qualitative content analysis. Interviews with 11 rheumatology nurses and 5 rheumatologists were completed. Three key themes emerged from the qualitative analysis: (i) Digital transformation of care; (ii) impact of digital transformation on health care delivery; and (iii) perceived drivers of successful digitalization. The interviews revealed that digital technologies are widely used throughout the complete patient pathway. Digitalization enables more continuity and flexibility in rheumatology care. Patient information can be electronically obtained in a standardized manner prior to planned visits, enabling an informed consultation and more time for in-depth patient discussion. Although digitalization restructures work, it can also increase the current workload. Improved accessibility for patient calls leads to more work for HCP. Important drivers of successful digital technology implementation are low-threshold and interoperable services, a medical team that is interested and educated in eHealth, and comprehensive patient information and onboarding. Digital transformation is increasingly redefining rheumatology care. While accelerating communication and workflows, improved service accessibility leads to more work for HCP.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | | | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Julian Schwarz
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | | | - Peer Aries
- Immunologikum Hamburg, Rheumatologie and Klinische Immunologie, Hamburg, Germany
| | - Martin Welcker
- MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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6
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Solomon M, Henao R, Economau-Zavlanos N, Smith I, Adagarla B, Overton AJ, Howe C, Doss J, Clowse M, Leverenz DL. Encounter Appropriateness Score for You Model: Development and Pilot Implementation of a Predictive Model to Identify Visits Appropriate for Telehealth in Rheumatology. Arthritis Care Res (Hoboken) 2024; 76:63-71. [PMID: 37781782 DOI: 10.1002/acr.25247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVE We aimed to develop a decision-making tool to predict telehealth appropriateness for future rheumatology visits and expand telehealth care access. METHODS The model was developed using the Encounter Appropriateness Score for You (EASY) and electronic health record data at a single academic rheumatology practice from January 1, 2021, to December 31, 2021. The EASY model is a logistic regression model that includes encounter characteristics, patient sociodemographic and clinical characteristics, and provider characteristics. The goal of pilot implementation was to determine if model recommendations align with provider preferences and influence telehealth scheduling. Four providers were presented with future encounters that the model identified as candidates for a change in encounter modality (true changes), along with an equal number of artificial (false) recommendations. Providers and patients could accept or reject proposed changes. RESULTS The model performs well, with an area under the curve from 0.831 to 0.855 in 21,679 encounters across multiple validation sets. Covariates that contributed most to model performance were provider preference for and frequency of telehealth encounters. Other significant contributors included encounter characteristics (current scheduled encounter modality) and patient factors (age, Routine Assessment of Patient Index Data 3 scores, diagnoses, and medications). The pilot included 201 encounters. Providers were more likely to agree with true versus artificial recommendations (Cohen's κ = 0.45, P < 0.001), and the model increased the number of appropriate telehealth visits. CONCLUSION The EASY model accurately identifies future visits that are appropriate for telehealth. This tool can support shared decision-making between patients and providers in deciding the most appropriate follow-up encounter modality.
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Affiliation(s)
| | | | | | | | | | | | - Catherine Howe
- Duke University Hospital and Duke University, Durham, North Carolina
| | | | - Megan Clowse
- Duke University Medical Center, Durham, North Carolina
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Berg IJ, Tveter AT, Bakland G, Hakim S, Kristianslund EK, Lillegraven S, Macfarlane GJ, Moholt E, Provan SA, Sexton J, Thomassen EE, De Thurah A, Gossec L, Haavardsholm EA, Østerås N. Follow-Up of Patients With Axial Spondyloarthritis in Specialist Health Care With Remote Monitoring and Self-Monitoring Compared With Regular Face-to-Face Follow-Up Visits (the ReMonit Study): Protocol for a Randomized, Controlled Open-Label Noninferiority Trial. JMIR Res Protoc 2023; 12:e52872. [PMID: 38150310 PMCID: PMC10782285 DOI: 10.2196/52872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/02/2023] [Accepted: 11/23/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Patients with chronic inflammatory joint diseases such as axial spondyloarthritis have traditionally received regular follow-up in specialist health care to maintain low disease activity. The follow-up has been organized as prescheduled face-to-face visits, which are time-consuming for both patients and health care professionals. Technology has enabled the remote monitoring of disease activity, allowing patients to self-monitor their disease and contact health care professionals when needed. Remote monitoring or self-monitoring may provide a more personalized follow-up, but there is limited research on how these follow-up strategies perform in maintaining low disease activity, patient satisfaction, safety, and cost-effectiveness. OBJECTIVE The Remote Monitoring in Axial Spondyloarthritis (ReMonit) study aimed to assess the effectiveness of digital remote monitoring and self-monitoring in maintaining low disease activity in patients with axial spondyloarthritis. METHODS The ReMonit study is a 3-armed, single-site, randomized, controlled, open-label noninferiority trial including patients with axial spondyloarthritis with low disease activity (Ankylosing Spondylitis Disease Activity Score <2.1) and on stable treatment with a tumor necrosis factor inhibitor. Participants were randomized 1:1:1 to arm A (usual care, face-to-face visits every sixth month), arm B (remote monitoring, monthly digital registration of patient-reported outcomes), or arm C (patient-initiated care, self-monitoring, no planned visits during the study period). The primary end point was disease activity measured with the Ankylosing Spondylitis Disease Activity Score, evaluated at 6, 12, and 18 months. We aimed to include 240 patients, 80 in each arm. Secondary end points included other measures of disease activity, patient satisfaction, safety, and cost-effectiveness. RESULTS The project is funded by the South-Eastern Norway Regional Health Authority and Centre for the treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Norway. Enrollment started in September 2021 and was completed with 242 patients by June 2022. The data collection will be completed in December 2023. CONCLUSIONS To our knowledge, this trial will be among the first to evaluate the effectiveness, safety, and cost-effectiveness of remote digital monitoring and self-monitoring of patients with axial spondyloarthritis compared with usual care. Hence, the ReMonit study will contribute important knowledge to personalized follow-up strategies for patients with axial spondyloarthritis. These results may also be relevant for other patient groups with inflammatory joint diseases. TRIAL REGISTRATION ClinicalTrials.gov NCT05031767; hpps://www.clinicaltrials.gov/study/NCT05031767. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52872.
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Affiliation(s)
- Inger Jorid Berg
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Health Sciences, Department of Rehabilitation Science and Health Technology, Oslo Metropolitan University, Oslo, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of North Norway, Tromsø, Norway
- Institute of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Tromsø, Tromsø, Norway
| | - Sarah Hakim
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik K Kristianslund
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Lillegraven
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), University of Aberdeen, Aberdeen, United Kingdom
| | - Ellen Moholt
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Sella A Provan
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Section for Public Health, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Joseph Sexton
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Emil Ek Thomassen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Annette De Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Laure Gossec
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France
- Rheumatology Department, Assistance Publique des Hopitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
| | - Espen A Haavardsholm
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Østerås
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Ponzano M, Tibert N, Brien S, Funnell L, Gibbs JC, Keller H, Laprade J, Morin SN, Papaioannou A, Weston ZJ, Wideman TH, Giangregorio LM. Development, Acceptability, and Usability of a Virtual Intervention for Vertebral Fractures. Phys Ther 2023; 103:pzad098. [PMID: 37555708 DOI: 10.1093/ptj/pzad098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 08/10/2023]
Abstract
OBJECTIVE This project aimed to develop a virtual intervention for vertebral fractures (VIVA) to implement the international recommendations for the nonpharmacological management of osteoporotic vertebral fractures and to test its acceptability and usability. METHODS VIVA was developed in accordance with integrated knowledge translation principles and was informed by the Behavioral Change Wheel, the Theoretical Domains Framework, and the affordability, practicability, effectiveness and cost-effectiveness, acceptability, side effects/safety, and equity (APEASE) criteria. The development of the prototype of VIVA involved 3 steps: understanding target behaviors, identifying intervention options, and identifying content and implementation options. The VIVA prototype was delivered to 9 participants to assess its acceptability and usability. RESULTS VIVA includes 7 1-on-1 virtual sessions delivered by a physical therapist over 5 weeks. Each session lasts 45 minutes and is divided in 3 parts: education, training, and behavioral support/goal setting. Four main themes emerged from the acceptability evaluation: perceived improvements in pain, increased self-confidence, satisfaction with 1-on-1 sessions and resources, and ease of use. All of the participants believed that VIVA was very useful and were very satisfied with the 1-on-1 sessions. Four participants found the information received very easy to practice, 4 found it easy to practice, and 1 found it somewhat difficult to practice. Five participants were satisfied with the supporting resources, and 4 were very satisfied. Potential for statistically significant improvements was observed in participants' ability to make concrete plans about when, how, where, and how often to exercise. CONCLUSION VIVA was acceptable and usable to the participants, who perceived improvements in pain and self-confidence. IMPACT The virtual implementation of the recommendations for the nonpharmacological management of vertebral fractures showed high acceptability and usability. Future trials will implement the recommendations on a larger scale to evaluate their effectiveness.
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Affiliation(s)
- Matteo Ponzano
- School of Health and Exercise Sciences, University of British Columbia, Kelowna BC, Canada
- International Collaboration on Repair Discoveries (ICORD), Blusson Spinal Cord Centre (BSCC), University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicholas Tibert
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Sheila Brien
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Larry Funnell
- Canadian Osteoporosis Patient Network, Osteoporosis, Toronto, ON, Canada
| | - Jenna C Gibbs
- Department of Kinesiology and Physical Activity, McGill University, Montreal, QC, Canada
| | - Heather Keller
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Judi Laprade
- Division of Anatomy, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Alexandra Papaioannou
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Zachary J Weston
- Canadian Society for Exercise Physiology (CSEP), Ottawa Ontario, Canada
- Faculty of Human and Social Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
| | - Timothy H Wideman
- School of Physical & Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Lora M Giangregorio
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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9
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Avouac J, Marotte H, Balsa A, Chebbah M, Clanche SL, Verhagen LAW, Filková M, Mueller RB, Mongey AB, Taylor PC. Teleconsultation in rheumatology: A literature review and opinion paper. Semin Arthritis Rheum 2023; 63:152271. [PMID: 37813005 DOI: 10.1016/j.semarthrit.2023.152271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 08/18/2023] [Accepted: 08/27/2023] [Indexed: 10/11/2023]
Abstract
In this article, we review published literature on "telerheumatology", a term describing the use of telemedicine in rheumatology. This field has received considerable recent attention through the development of efficient digital technologies, resulting in a good level of satisfaction among patients and health care professionals. In 2020, the social distancing constraints during the COVID-19 pandemic accelerated more widespread adoption worldwide. Telerheumatology is particularly suited for patients with rheumatoid arthritis who have achieved a sustained therapeutic target of remission or low disease activity. To facilitate remote consultations and meet expectations of rheumatologists and patients, international and national guidelines have recently been proposed and existing tools, such as Patient-Reported Outcomes questionnaires, have had to be digitally adapted. In addition, telerheumatology toolkits are proposed by the Arab League of Associations for Rheumatology (ArLAR), the Association of American Medical College (AAMC), and the American College of Rheumatology (ACR) for all learners, from medical students to practicing clinicians, encouraging the acquisition of telehealth skills and facilitating their integration into their routine clinical practice. The main benefits reported for this mode of health care are greater access to specialty care, flexibility, reduced rates of missed appointments, as well as improved patient engagement and autonomy. Limitations include the absence of physical examination. However, to implement telerheumatology effectively and widely in daily clinical practice, some barriers still need to be addressed. These include training of health care professionals, technological restrictions and reimbursement mechanisms. Despite the advantages of telerheumatology, it is not intended to replace face-to-face visits, but rather as a way to enhance access to care, service delivery and health care support for patients.
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Affiliation(s)
- Jérôme Avouac
- Service de Rhumatologie, Hôpital Cochin, AP-HP Centre - Université Paris Cité, 75014 Paris, France
| | - Hubert Marotte
- SAINBIOSE, INSERM U1059, Université Jean Monnet, Saint-Etienne, France; Service de Rhumatologie, CHU Saint-Etienne,42055 Saint-Etienne, France; CIC 1408, Saint-Etienne, France
| | - Alejandro Balsa
- Rheumatology Unit, University Hospital La Paz, Institute for Health Research-IdiPAZ, Universidad Autonoma de Madrid,28046 Madrid, Spain
| | - Myriam Chebbah
- Public Health Expertise, Département Affaires Médicales, 10 boulevard de Sébastopol, 75004 Paris, France
| | - Solenn Le Clanche
- Public Health Expertise, Département Affaires Médicales, 10 boulevard de Sébastopol, 75004 Paris, France
| | | | - Mária Filková
- Institute of Rheumatology, Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Peter C Taylor
- Norman Collison Professor of Musculoskeletal Sciences at the Botnar Research Centre, NDORMS, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK.
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10
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Wu B, Zhang M, Hu H, Wu X. The Effectiveness of Telemedicine in Patients with Rheumatoid Arthritis: An Overview of Systematic Reviews and Meta-Analysis. Telemed J E Health 2023; 29:1747-1758. [PMID: 37074335 DOI: 10.1089/tmj.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
Introduction: Although telemedicine is widely used in the field of rheumatoid arthritis (RA), many systematic reviews have evaluated telemedicine, but we still have no clear effect on RA and no evidence summary. Our aim is to determine the effectiveness of telemedicine on different health outcomes of RA. Methods: The following sources were used: PubMed, Cochrane, Web of Science, Cumulative Index to Nursing and Allied Health Literature, and Embase. The publication period was from the establishment of the database to May 12, 2022. Methodological and reporting qualities were assessed using A Measurement Tool to Assess Systematic Reviews 2 and Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Each intervention's evidence of effect was graded in accordance with the Grades of Recommendations Assessment, Development and Evaluation standards. The comparison of systematic reviews and the investigation of the impact of telemedicine on various outcomes were carried out through a meta-analysis of original studies. Results: Eight systematic reviews were included. The results showed that telemedicine imparted significant improvements in patients with RA in terms of disease activity, function, physical activity, self-efficacy, and knowledge. Conclusions: Telemedicine can improve the overall standard of care for patients with RA. In the future, standardized telemedicine processes should be developed to protect patients.
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Affiliation(s)
- Bilin Wu
- School of Nursing, Peking University, Beijing, China
| | | | - Huiling Hu
- School of Nursing, Peking University, Beijing, China
| | - Xue Wu
- School of Nursing, Peking University, Beijing, China
- Evidence-Based Nursing: A Joanna Briggs Institute Center of Excellence, Health Science Center, Peking University, Beijing, China
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11
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Arumalla N, Chan CKD, Gibson M, Man YL, Adas MA, Norton S, Galloway JB, Garrood T. The Clinical Impact of Electronic Patient-Reported Outcome Measures in the Remote Monitoring of Inflammatory Arthritis: A Systematic Review and Meta-analysis. Arthritis Rheumatol 2023; 75:1892-1903. [PMID: 37204273 DOI: 10.1002/art.42559] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 04/28/2023] [Accepted: 05/05/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE The inflammatory arthritides (IAs) make up a significant proportion of conditions followed up in rheumatology clinics. These patients require regular monitoring, but this is increasingly difficult with rising patient numbers and demand on clinics. Our objective is to evaluate the clinical impact of electronic patient-reported outcome measures (ePROMs) as a digital remote-monitoring intervention on disease activity, treatment decisions, and health care resource use in patients with IA. METHODS Five databases (MEDLINE, Embase, PubMed, Cochrane Library, and Web of Science) were searched, with randomized controlled trials and (nonrandomized) controlled clinical trials included, and meta-analysis and forest plots conducted for each outcome. Risk of bias was assessed using the Risk of Bias-2 tool and Risk of Bias in Nonrandomized Studies of Interventions. RESULTS Eight studies were included with a total of 4,473 patients, with seven studies assessing patients with rheumatoid arthritis. Compared with control, the disease activity in the ePROM group was lower (standardized mean difference [SMD] -0.15; 95% confidence interval [CI] -0.27 to -0.03) and rates of remission/low disease activity were higher (odds ratio1.65; 95% CI 1.02-2.68), but five of eight studies provided additional combined interventions (e.g., disease education). Fewer face to face visits were needed in the remote ePROM group (SMD -0.93; 95% CI -2.14-0.28). CONCLUSION Most studies were at high risk of bias with significant heterogeneity in design, but our results suggest there is an advantage in using ePROM monitoring in patients with IAs, with the potential for reduction in health care resource use without detrimental impact in disease outcomes.
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Affiliation(s)
| | | | | | - Yik L Man
- Lewisham and Greenwich NHS Trust, London, UK
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12
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Civi Karaaslan T, Tarakci E, Keles O, Aslan Keles Y, Ugurlu S. Comparison of telerehabilitation methods for patients with systemic sclerosis in the COVID-19 Era: A randomized controlled study. J Hand Ther 2023; 36:751-769. [PMID: 37574373 DOI: 10.1016/j.jht.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 08/15/2023]
Abstract
STUDY DESIGN This was a single-blinded randomized clinical trial. INTRODUCTION Systemic sclerosis (SSc) is an autoimmune connective tissue disease that progresses with fibrosis. Patients with SSc need to be protected against epidemic diseases and provided for in terms of rehabilitation needs. PURPOSE OF THE STUDY To compare the effects of real-time telerehabilitation (RTT) and asynchronous telerehabilitation (AT) on individuals with SSc. METHODS Forty-two participants with SSc with a mean age of 44.17 ± 11.05 years were included in the study. The patients were randomly divided into three groups, RTT (n = 16), AT (n = 16), and control (n = 16) groups. A structured rehabilitation program was performed in real-time (RTT group) and asynchronously (AT group) for 40 minutes per day, in three sessions per week for 8 weeks. The participants' finger and wrist joint range of motion (ROM), upper extremity functions, grip strength, superficial sense of touch, activities of daily living (ADL), and general health status were assessed at baseline and after treatment. RESULTS After 8 weeks, there were improvements in finger ROM (effect size [ES] = 0.23 to 0.60), wrist ROM (ES = 0.45 to 0.83), upper extremity functions (ES = 0.61 to 1.00), and ADL parameters (ES = 0.74) in the RTT group (p < 0.05). Also, there were improvements in finger ROM (ES = 0.16 to 0.45) and hand functions (ES = 0.54 to 0.55) in the AT group (p < 0.05). The RTT and AT groups had better hand functions and finger ROM than the control group in (p < 0.05). In addition, the RTT group had better wrist ROM than the control group (p = 0.008). RTT was superior to AT only in lateral pinch strength (p = 0.025). DISCUSSION Experimental groups achieved a statistically significant change in ROM, upper extremity functions and ADL over time in concordance with prior investigations. Changes in grip strength, superficial sense of touch, and general health status scores differed from previous investigations and the between-group comparison was not statistically significant. CONCLUSIONS Both RTT and AT may be effective in individuals with SSc, and RTT has additional benefits.
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Affiliation(s)
- Tugba Civi Karaaslan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ela Tarakci
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozal Keles
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Bitlis Eren University, Bitlis, Turkey
| | - Yasemin Aslan Keles
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey; Department of Therapy and Rehabilitation, Physiotherapy Program, Vocational School, Biruni University, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Tharwat S, Gamal D. The Attitude of Egyptian Patients with Autoimmune and Rheumatic Diseases towards Telemedicine. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1595. [PMID: 37763714 PMCID: PMC10533084 DOI: 10.3390/medicina59091595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/01/2023] [Accepted: 09/02/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: The use of telemedicine (TM) has recently undergone rapid growth and proliferation. Professional stakeholders anticipate that TM will aid in the efficient allocation of limited resources in rheumatology care. The aim of the study was to evaluate the acceptance and willingness of Egyptian patients with autoimmune and rheumatic diseases (ARDs) to incorporate TM into rheumatological care and to assess their requirements and concerns regarding TM. Materials and Methods: A cross-sectional questionnaire-based study was conducted among Egyptian patients with ARDs. The questionnaire covered sociodemographic characteristics, clinical and therapeutic data, attitudes, barriers, and motivators towards TM. Results: The study included 189 patients with ARDs, with a mean age of 37 years (SD = 11.71), and 88.4% were females. Participants were divided into two groups based on their acceptance of TM: the non-acceptant group (133, 70.4%) and the acceptant group (56, 29.6%). There was a significant difference in educational level (p = 0.001), chronic kidney and heart disease (p = 0.008 and 0.014, respectively) and hydroxychloroquine administration (p = 0.037) between the two groups. During the coronavirus disease 2019 (COVID-19) pandemic, 96 (50.8%) of participants used virtual rheumatology consultations, mainly using WhatsApp (64.6%). Approximately 87% would require assistance in operating TM technology. The preference for direct conversation with the rheumatologist and the need for physical examination were the main barriers to teleconsultation. Conclusions: TM is opposed by the vast majority of Egyptian patients with ARDs. They are concerned since it does not include a physical examination and prevents them from undergoing additional procedures such as ultrasound and blood testing. The majority of Egyptian patients with ARDs need help using TM technology, which is the most significant barrier to the spread of TM.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta 34517, Egypt
| | - Doaa Gamal
- Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura 35511, Egypt;
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Ducrocq Q, Guédon-Moreau L, Launay D, Terriou L, Morell-Dubois S, Maillard H, Lefèvre G, Sobanski V, Lambert M, Yelnik C, Farhat MM, Garcia Fernandez MJ, Hachulla E, Sanges S. Activities of Clinical Expertise and Research in a Rare Disease Referral Centre: A Place for Telemedicine beyond the COVID-19 Pandemic? Healthcare (Basel) 2023; 11:2447. [PMID: 37685481 PMCID: PMC10487162 DOI: 10.3390/healthcare11172447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/26/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
INTRODUCTION Rare disease referral centres are entrusted with missions of clinical expertise and research, two activities that have to contend with numerous obstacles. Providing specialist opinions is time-consuming, uncompensated and limited by difficulties in exchanging medical data. Clinical research is constrained by the need for frequent research protocol visits. Our objective was to determine whether telemedicine (TLM) can overcome these difficulties. METHODS To better characterise the activity of clinical expertise provided by our French centre, each opinion delivered by our team was reported on a standardised form. To investigate our clinical research activity, investigators and patients were asked to complete a questionnaire on the acceptability of research protocol teleconsultations. RESULTS Regarding clinical expertise, our team delivered 120 opinions per week (representing a total of 21 h), of which 29% were delivered to patients and 69% to medical practitioners. If these were delivered using TLM, it would represent a potential weekly income of EUR 500 (tele-expertise) and EUR 775 (teleconsultations). Regarding the research activity, 70% of investigators considered the frequency of visits to be a limiting factor for patient inclusions; nearly half of the patients surveyed would be in favour of having teleconsultations in place of (40%) or in addition to (56%) in-person visits. CONCLUSION Whereas TLM has become widely used as a back-up procedure to in-person consultations during the COVID-19 pandemic, the solutions it provides to the problems encountered in performing expertise and research activities have made it a new conventional follow-up modality for patients with rare diseases.
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Affiliation(s)
- Quentin Ducrocq
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
| | - Laurence Guédon-Moreau
- Université de Lille, Faculté de Médecine et CHU de Lille, Clinique de Cardiologie et Maladies Vasculaires, F-59000 Lille, France;
| | - David Launay
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Louis Terriou
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
| | - Sandrine Morell-Dubois
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Hélène Maillard
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Guillaume Lefèvre
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- CHU Lille, Laboratoire d’Immunologie, F-59000 Lille, France
| | - Vincent Sobanski
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Marc Lambert
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
- CHU Lille, Département de Médecine Polyvalente Post-Urgences, F-59000 Lille, France
- Univ. Lille, U1167—RIDAGE—Risk Factors and Molecular Determinants of Aging-Related Diseases, F-59000 Lille, France
| | - Cécile Yelnik
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
- CHU Lille, Département de Médecine Polyvalente Post-Urgences, F-59000 Lille, France
- Univ. Lille, U1167—RIDAGE—Risk Factors and Molecular Determinants of Aging-Related Diseases, F-59000 Lille, France
| | - Meryem-Maud Farhat
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Maria José Garcia Fernandez
- Unité Matériaux et Transformations (UMET) UMR CNRS 8207, Université Lille 1, F-59655 Villeneuve d’Ascq, France;
- Inserm, CHU Lille, U1008—Controlled Drug Delivery System and Biomaterials, University Lille, F-59000 Lille, France
| | - Eric Hachulla
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
| | - Sébastien Sanges
- CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Auto-Immunes Systémiques Rares du Nord et Nord-Ouest de France (CeRAINO), F-59000 Lille, France; (Q.D.); (D.L.); (L.T.); (S.M.-D.); (H.M.); (V.S.); (M.L.); (C.Y.); (M.-M.F.); (E.H.)
- Univ. Lille, U1286—INFINITE—Institute for Translational Research in Inflammation, F-59000 Lille, France;
- Inserm, F-59000 Lille, France
- Health Care Provider of the European Reference Network on Rare Connective Tissue and Musculoskeletal Diseases Network (ReCONNET), F-59000 Lille, France
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15
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Trenaman L, Kaal KJ, Laba TL, Safari A, Aguiar M, Burch T, Beckett J, Munro S, Hudson M, Harrison M. The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey. CMAJ Open 2023; 11:E630-E636. [PMID: 37437955 PMCID: PMC10356003 DOI: 10.9778/cmajo.20220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities. METHODS We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins. RESULTS The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458). INTERPRETATION Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - K Julia Kaal
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tracey-Lea Laba
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Abdollah Safari
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Magda Aguiar
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tiasha Burch
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Jennifer Beckett
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Marie Hudson
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
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16
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Post AA, Rio EK, Sluka KA, Moseley GL, Bayman EO, Hall MM, de Cesar Netto C, Wilken JM, Danielson J, Chimenti RL. Efficacy of Telehealth for Movement-Evoked Pain in People With Chronic Achilles Tendinopathy: A Noninferiority Analysis. Phys Ther 2023; 103:pzac171. [PMID: 37172125 PMCID: PMC10071585 DOI: 10.1093/ptj/pzac171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The purpose of this study was to compare the efficacy of physical therapy delivered via an all telehealth or hybrid format with an all in-person format on movement-evoked pain for individuals with chronic Achilles tendinopathy (AT). METHODS Sixty-six individuals with chronic AT participated (age, 43.4 [SD = 15.4] years; 56% female; body mass index, 29.9 [SD = 7.7] kg/m2). Participants completed all in-person visits from the initiation of recruitment in September 2019 to March 16, 2020 (in-person group). From March 17 to July 15, 2020, participants completed all telehealth visits (telehealth group). From July 16, 2020, to enrollment completion in December 2020, participants could complete visits all in-person, all telehealth, or a combination of in-person and telehealth (hybrid group) based on their preference. A physical therapist provided 6 to 7 visits, including an exercise program and patient education. Noninferiority analyses of the telehealth and hybrid groups compared with the in-person group were completed for the primary outcome of movement-evoked pain during single-limb heel raises. RESULTS All groups demonstrated decreases in movement-evoked pain beyond the minimal clinically important difference from baseline to 8 weeks (2 out of 10 on a numeric pain rating scale). Lower bounds of the 95% CIs for mean differences between groups did not surpass the preestablished noninferiority margin (2 out of 10) for movement-evoked pain in both the telehealth and hybrid groups (telehealth vs in-person: 0.45 [-1.1 to 2.0]; hybrid vs in-person: 0.48 [-1.0 to 1.9]). CONCLUSION Individuals with chronic AT who completed a tendon-loading program with patient education through a telehealth or hybrid format had no worse outcomes for pain than those who received the same intervention through in-person visits. IMPACT Physical therapist-directed patient care delivered via telehealth may enhance accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also provide an opportunity to prioritize patient preference for physical therapy visit format. LAY SUMMARY If you are a patient with chronic AT, physical therapist-directed patient care delivered via telehealth may improve your accessibility to best practice AT rehabilitation, including exercise and education. Use of telehealth technology may also prioritize your preferences regarding the format of the physical therapy visit.
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Affiliation(s)
- Andrew A Post
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Ebonie K Rio
- La Trobe Sport and Exercise Medicine Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kathleen A Sluka
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - G Lorimer Moseley
- University of South Australia, IMPACT in Health, Kaurna Country, Adelaide, Australia
| | - Emine O Bayman
- Department of Biostatistics, The University of Iowa, Iowa City, Iowa, USA
- Department of Anesthesia, The University of Iowa, Iowa City, Iowa, USA
| | - Mederic M Hall
- University of Iowa Sports Medicine, Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, Iowa, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, The University of Iowa, Iowa City, Iowa, USA
| | - Jason M Wilken
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
| | - Jessica Danielson
- Institute for Clinical and Translational Science, The University of Iowa, Iowa City, Iowa, USA
| | - Ruth L Chimenti
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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17
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Skovsgaard CV, Kruse M, Hjollund N, Maribo T, de Thurah A. Cost-effectiveness of a telehealth intervention in rheumatoid arthritis: economic evaluation of the Telehealth in RA (TeRA) randomized controlled trial. Scand J Rheumatol 2023; 52:118-128. [PMID: 35048793 DOI: 10.1080/03009742.2021.2008604] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Telehealth is rapidly gaining ground from usual treatment, not least because of coronavirus disease 2019 (COVID-19) measures. Within rheumatology, telehealth has been used for, inter alia, follow-up for patients with rheumatoid arthritis (RA) with low disease activity or in remission. This study aims to assess the cost-effectiveness of such a telehealth intervention. METHOD In a randomized controlled trial, 294 patients were randomized into patient-reported outcome-based telehealth follow-up by either a nurse (PRO-TN) or a rheumatologist (PRO-TR) or to conventional outpatient follow-up (control). Cost-effectiveness was evaluated using costs per quality-adjusted life-year (QALY) gained. Individual-level healthcare and productivity costs were retrieved from national Danish registers. Incremental cost-effectiveness ratios were calculated for the intervention groups compared to the control group. Bootstrapping with 10 000 replications was used to obtain confidence intervals. Furthermore, cost-effectiveness acceptability curves were generated. RESULTS The cost comparison showed that PRO-TR was significantly less costly than the control group, whereas the relative reduction in costs for PRO-TN was not significant. The telehealth groups experienced minor, non-significant declines in QALYs, whereas the control group experienced a slight, non-significant increase. The cost-effectiveness analysis showed that for PRO-TR, the willingness to accept a QALY loss was 89 328 EUR. A similar but smaller and non-significant result was seen for PRO-TN. CONCLUSION PRO-TR and PRO-TN seem to cost less but provide broadly similar health outcomes compared with conventional follow-up. Between the intervention groups, PRO-TR was significantly less costly. More studies are needed to conclude whether rheumatologist- or nurse-led telehealth is more cost-effective than conventional follow-up.
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Affiliation(s)
- C V Skovsgaard
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - M Kruse
- Department of Public Health, Danish Centre for Health Economics, University of Southern Denmark, Odense, Denmark
| | - Nhi Hjollund
- AmbuFlex, Center for Patient-reported Outcomes, Hospital Unit West Jutland, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - T Maribo
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Public Health and Rehabilitation Research, DEFACTUM, Central Denmark Region, Aarhus, Denmark
| | - A de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
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18
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Godziuk K, Prado CM, Quintanilha M, Forhan M. Acceptability and preliminary effectiveness of a single-arm 12-week digital behavioral health intervention in patients with knee osteoarthritis. BMC Musculoskelet Disord 2023; 24:129. [PMID: 36797720 PMCID: PMC9936108 DOI: 10.1186/s12891-023-06238-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Digital health interventions may improve osteoarthritis (OA) management. This study evaluated the acceptability and preliminary effectiveness of a multimodal digital nutrition, exercise, and mindfulness intervention in adults with knee OA. METHODS Adults with advanced knee OA and an orthopaedic referral were invited to self-enroll in a pragmatic 12-week single-arm intervention. OA-focused nutrition and exercise resources were delivered weekly by email, and secondary components accessed on-demand (web-platform, webinars, and nutrition consultation). Acceptability was assessed by qualitative interview data and completion rates. Preliminary effectiveness on clinical outcomes was assessed by change in health-related quality of life, well-being, mindfulness, self-efficacy, and interest in total knee arthroplasty (TKA) between baseline and 12-weeks. RESULTS N = 102 patients self-enrolled (73.5% female, age 64 ± 7 years, body mass index 32.9 ± 7.3 kg/m2); n = 53 completed the 12-week intervention (71.7% female, age 65 ± 7 years, body mass index 33.4 ± 6.3 kg/m2). Acceptability was demonstrated by positive perceptions of tailored intervention resources. In study completers, health-related quality of life components of pain and physical functioning domains improved at 12-weeks [change in SF36 4.4 (95%CI 0.2-8.6), p = 0.016, and 6.7 (95%CI 2.7-10.7), p < 0.001, respectively]. Self-efficacy for managing daily activities improved [change in PROMIS T-score 4.4 (95%CI 2.8-6.0), p < 0.001]. CONCLUSION A 12-week digital multimodal intervention for knee OA was acceptable to patients and shows preliminary effectiveness in improving self-efficacy, aspects of quality of life, and decreasing interest in TKA. Digital behavioral interventions for knee OA may be an acceptable approach to improve patient outcomes and OA self-management while potentially reducing utilization of costly health system resources.
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Affiliation(s)
- Kristine Godziuk
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB, T6G 2P5, Canada.
| | - Carla M. Prado
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Maira Quintanilha
- grid.17089.370000 0001 2190 316XDepartment of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, 2-004 Li Ka Shing Centre, Edmonton, AB T6G 2P5 Canada
| | - Mary Forhan
- grid.17063.330000 0001 2157 2938Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON Canada
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19
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Eysenbach G, Petit P, Knitza J, Welcker M, Vuillerme N. Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey. J Med Internet Res 2023; 25:e40912. [PMID: 36705950 PMCID: PMC9919449 DOI: 10.2196/40912] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians' willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients' motivation to use TM. OBJECTIVE This study aims to identify the factors that determine patients' willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). METHODS We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All the analyses were stratified by sex. RESULTS Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ≤5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner's office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one's health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. CONCLUSIONS Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support.
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Affiliation(s)
| | - Pascal Petit
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Johannes Knitza
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Institut Universitaire de France, Paris, France.,LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
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20
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[How many patients with inflammatory rheumatic diseases have the technical prerequisites for video consultations and are also willing to use this to carry out visits by medical specialist visits?]. Z Rheumatol 2023; 82:102-107. [PMID: 34152435 PMCID: PMC8215311 DOI: 10.1007/s00393-021-01026-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The currently disseminating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and limited capacities in outpatient rheumatological care, pose questions about possible alternatives to clinical visits, also in view of the digital revolution. It is unclear whether and to what extent patients with inflammatory rheumatic diseases are willing and in a position to deal with the new media, such as video consultation. METHODS In the middle of the pandemic in May 2020 outpatients were surveyed using a standardized questionnaire in order to document their possibilities and willingness to participate in a video consultation. The treating physicians were asked whether carrying out a video consultation was considered to be a possible and meaningful option. RESULTS Overall, 232 patients with inflammatory rheumatic diseases were surveyed (64.7% female, average age 54.0 ± 15.2 years), seropositive (n = 58) and seronegative (n = 51) rheumatoid arthritis (RA), spondyloarthritis (SpA, n = 77) including axial SpA (axSpA) and psoriatic arthropathy (PsA) as well as collagenosis and vasculitis (CoV, n = 46). The mean duration of disease was 5.5 ± 8.2 years, whereby in 75 patients (32.3%) it was the first diagnosis. The mean disease activity (0-10, subjective patient self-estimation) was 4.7 ± 2.5. Overall, 176 patients were basically aware of the possibility to carry out video consultations (75.9%) and 166 considered that they were technically capable to participate (71.6%) but only 131 were principally willing to participate (56.5%). Logistic regression analyses showed that the willingness to participate in video consultations decreased with increasing age (β = 0.28, p = 0.01). According to the medical estimation video consultations were thought to be principally possible for 161 patients for technical reasons (69.4%) and for 127 for medical reasons (54.7%); however, a video consultation within the framework of treatment was only considered to be meaningful by the physician for 76 patients (32.8%). CONCLUSION Not all patients can or want to participate in video consultations and the willingness declines with increasing age. The estimation of the meaningfulness of video consultations by physicians was also limited to approximately one third of the patients surveyed. This must be taken into consideration for the future planning of video consultations.
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21
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Makhlouf Y, Nessib DB, Ferjani H, Triki W, Maatallah K, Dhia K, Hamdi. The concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions. J Pediatr Nurs 2022; 69:6-9. [PMID: 36584592 PMCID: PMC9797351 DOI: 10.1016/j.pedn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION With the COVID-19 pandemic, health care systems are facing challenges in delivering proper patient care. Children and adolescents with juvenile idiopathic arthritis require specialized and comprehensive attention. In this context, telemedicine is an alternative that has the potential to improve access to healthcare in addition to cost savings. The objective of our study was to evaluate parents' willingness for telemedicine and factors helping to adopt this alternative in the era of COVID-19. METHODS We undertook a cross-sectional study via structured phone interviews of parents' JIA patients as well as those with no established diagnoses. We evaluated their point of view and willingness to adhere to TM. RESULTS The study included 40 parents. The main reasons for favoring TM were avoiding hospitals during the pandemic (32.5%), time saving (27.5%) as well as avoiding school absenteeism (27.5%). The main reasons for preferring a live consultation were the fear of a possible discrepancy between physical and distant evaluation (47.5%) and the fear of the trivialization of the disease (38.5%). There was no association between preference for TM and a family history of COVID-19 (p = 0.704) as well as electronic devices afforded (p = 0.263). However, patients who lived away from hospital, not familiar with the concept of TM and with higher income adhered less to TM. CONCLUSION Unlike the literature data, our study showed the low prevalence of parents willing to accept TM as a model of care. This imply an urgent need for parent and patient education to promote TM especially in pediatric rheumatology.
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Affiliation(s)
- Yasmine Makhlouf
- Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia.
| | - Dorra Ben Nessib
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Hanene Ferjani
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia.
| | - Wafa Triki
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Kaouther Maatallah
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Kaffel Dhia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Hamdi
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
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22
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Machado PM, Verschueren P, Grainger R, Jones H, Piercy J, van Beneden K, Caporali R, Dejaco C, Fautrel B. Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries. Rheumatol Adv Pract 2022; 7:rkac108. [PMID: 36601518 PMCID: PMC9800854 DOI: 10.1093/rap/rkac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.
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Affiliation(s)
- Pedro M Machado
- Correspondence to: Pedro M. Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10–12 Russell Square, London WC1B 5EH, UK. E-mail:
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hannah Jones
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - James Piercy
- Health Economics and Outcomes Research, Adelphi Real World, Bollington, UK
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy
| | | | - Bruno Fautrel
- Service de Rhumatologie, Sorbonne Université-Assistance Publique-Hôpitaux de Paris, Paris, France
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Guaracha-Basáñez GA, Contreras-Yáñez I, Estrada-González VA, Estrada-González VA, Valverde-Hernández SS, Hernández-Molina G, Pascual-Ramos V. Comparison of Teleconsultations and In-Person Consultations from Outpatients with Rheumatoid Arthritis, During the COVID-19 Pandemic: An Internal Audit of Medical Notes. Telemed J E Health 2022; 28:1835-1842. [PMID: 35506921 DOI: 10.1089/tmj.2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The objectives of this study were to compare the quality-of-care and compliance with medical record regulations between in-person consultations (QIP and CIP) and telephone consultations (QTP and CTP), from rheumatoid arthritis (RA) outpatients, during the COVID-19 pandemic, and to explore the impact of the consultation modality on the treatment. Methods: Data from 324 medical notes corresponding to rheumatic consultations between July and December 2020 were abstracted. Notes were selected considering a stratified (in-person and telephone consultations) random sampling strategy. QIP, CIP, QTP, and CTP were scored based on prespecified criteria as percentages, where higher numbers translated into better standards. Logistic regression analysis investigated the association between the consultation modality and the treatment recommendation (dependent variable). Results: There were 208 (64.2%) medical notes related to in-person consultations and 114 (35.2%) to telephone consultations. Overall, medical notes corresponded to middle-aged women with long-standing disease. QIP was superior to QTP (median, interquartile range): 60% (60-75%) versus 50% (25-60%), p ≤ 0.001, and differences were related to disease activity and prognosis documentation (81.3% vs. 34.5% and 55.8% vs. 33.6%, respectively, p ≤ 0.001) and the prolonged prescription of glucocorticoids with a documented management plan (58.5% vs. 30.4%, p = 0.045). Meanwhile, CIP and CTP were similar. Telephone consultation was a significant risk factor for no changes in the treatment recommendation (odds ratio: 2.113, 95% confidence interval: 1.284-3.479, p = 0.003), and results were consistent in the 142 medical notes with documented absence of disease activity. Conclusions: In the clinical context of RA, the quality-of-care provided by telephone consultations is below the standard of care and impacts the treatment.
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Affiliation(s)
- Guillermo A Guaracha-Basáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Salvador S Valverde-Hernández
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
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Hormaza-Jaramillo A, Arredondo A, Forero E, Herrera S, Ochoa C, Arbeláez-Cortés Á, Fernandez Aldana AR, Rodriguez A, Amador L, Castaño N, Reyes J. Effectiveness of Telemedicine Compared with Standard Care for Patients with Rheumatic Diseases: A Systematic Review. Telemed J E Health 2022; 28:1852-1860. [PMID: 35834601 DOI: 10.1089/tmj.2022.0098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective: The aim of this study was to systematically review the evidence on the effectiveness of telemedicine compared to standard care for patients with rheumatic diseases. Methods: A search was performed in MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews; for the gray literature, GREYNET databases and a snowball search were used. MeSH or Emtree terms. Three authors independently selected systematic reviews, randomized controlled trail (RCTs), or non-RCTs with patients with autoimmune or inflammatory rheumatic diseases, where telemedicine was compared with standard care. Effectiveness was measured in terms of disease activity, quality of life, and functional activity. The patients' satisfaction was also measured. The risk of bias was assessed by the Cochrane collaboration tool for RCTs and AMSTAR II for systematic reviews. Results: Four RCTs, one cross-out study, and five systematic reviews were included. The studies were conducted with rheumatoid arthritis patients, and one study involved patients with systematic lupus erythematosus. The interventions mainly involved teleconsultation and telemonitoring, with patient-reported outcomes (PROs) being compared with standard care. Four studies measured the effectiveness of telemedicine using PROs, in which three of the RCTs did not find differences in the clinical outcomes, and one found that telemedicine improved the remission of diseases, functional impairment, and radiographic joint damage progression. Two studies measured patient satisfaction with telemedicine and standard care without a significant difference between the groups. Conclusions: Despite heterogeneity between studies, the findings were remarkably consistent in demonstrating that there was no significant difference between the telemedicine group and the control group in terms of PROs and patient satisfaction. Patients should be offered the option of telemedicine to manage their diseases as part of health-care support. Further research is needed on the effectiveness of telemedicine in the long term for patients with rheumatic diseases.
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Affiliation(s)
| | - Ana Arredondo
- Internal Medicine and Rheumatology Fundacion Universitaria de Ciencias de la Salud, Bogota, Colombia
- Rheumatology, Hospital de San Jose, Bogota, Colombia
- Rheumatology, Clinicos IPS, Bogota, Colombia
| | - Elias Forero
- Rheumatology, Universidad del Norte, Barranquilla, Colombia
| | - Sebastian Herrera
- Rheumatology, ARTMEDICA, Medellin, Colombia
- Rheumatology, Clinica Las Americas, Medellin, Colombia
| | - Carlos Ochoa
- Rheumatology, Centro de Reumatologia, Bogota, Colombia
| | - Álvaro Arbeláez-Cortés
- Rheumatology, Clinica Imbanaco Grupo Quiron salud, Cali, Colombia
- Internal Medicine, Universidad Libre, Cali, Colombia
| | | | - Andrea Rodriguez
- Clinical Epidemiology, National University of Colombia, Bogota, Colombia
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Muehlensiepen F, Petit P, Knitza J, Welcker M, Vuillerme N. Factors Associated With Telemedicine Use Among German General Practitioners and Rheumatologists: Secondary Analysis of Data From a Nationwide Survey. J Med Internet Res 2022; 24:e40304. [DOI: 10.2196/40304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/20/2022] [Accepted: 09/28/2022] [Indexed: 12/05/2022] Open
Abstract
Background
Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the SARS-CoV-2 pandemic, TM experienced a massive upswing. However, in rheumatology care, the use of TM stagnated again shortly thereafter. Consequently, the factors associated with physicians’ willingness to use TM (TM willingness) and actual use of TM (TM use) need to be thoroughly investigated.
Objective
This study aimed to identify the factors that determine TM use and TM willingness among German general practitioners and rheumatologists.
Methods
We conducted a secondary analysis of data from a German nationwide cross-sectional survey with general practitioners and rheumatologists. Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM use and TM willingness. The predictor variables (covariates) that were studied individually included sociodemographic factors (eg, age and sex), work characteristics (eg, practice location and medical specialty), and self-assessed knowledge of TM. All the variables positively and negatively associated with TM use and TM willingness in the univariate analysis were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All analyses were stratified by sex.
Results
Univariate analysis revealed that out of 83 variables, 36 (43%) and 34 (41%) variables were positively or negatively associated (region of practical equivalence≤5%) with TM use and TM willingness, respectively. The Bayesian model averaging analysis allowed us to identify 13 and 17 factors of TM use and TM willingness, respectively. Among these factors, being female, having very poor knowledge of TM, treating <500 patients per quarter, and not being willing to use TM were negatively associated with TM use, whereas having good knowledge of TM and treating >1000 patients per quarter were positively associated with TM use. In addition, being aged 51 to 60 years, thinking that TM is not important for current and future work, and not currently using TM were negatively associated with TM willingness, whereas owning a smart device and working in an urban area were positively associated with TM willingness.
Conclusions
The results point to the close connection between health care professionals’ knowledge of TM and actual TM use. These results lend support to the integration of digital competencies into medical education as well as hands-on training for health care professionals. Incentive programs for physicians aged >50 years and practicing in rural areas could further encourage TM willingness.
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Wu W, Zhang Y, Zhang Y, Peng B, Xu W. Clinical Effectiveness of Home-Based Telerehabilitation Program for Geriatric Hip Fracture Following Total Hip Replacement. Orthop Surg 2022; 15:423-431. [PMID: 36448261 PMCID: PMC9891946 DOI: 10.1111/os.13521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 08/08/2022] [Accepted: 08/24/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of a six-month home-based telerehabilitation based on the Internet-based rehabilitation management system coupled with conventional outpatient care in elderly patients with hip fractures following total hip replacement (THR). METHODS Elderly patients (aged over 65 years) with first hip fractures who underwent THR between March 2018 and September 2018 in Tianjin Hospital were enrolled in this study. Patients were divided into two groups: telerehabilitation group (n = 43) and telephone group (n = 42). A Internet-based telerehabilitation management system was established and applied on patients in the telerehabilitation group. For patients in the telephone group, the rehabilitation intervention was administered through conventional outpatient care (telephone along with outpatient follow-up). Data from the Harris hip scale (HHS), functional independence measure (FIM), self-rating anxiety scale (SAS), and postoperative complications at 1, 3, and 6 months after surgery were collected and compared between the two groups. RESULTS A total of 85 elderly patients completed the 6-month follow-up assessment. Results showed that the HHS score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (66.35 ± 4.63 vs 63.48 ± 4.49), 3 months (76.33 ± 4.52 vs 71.81 ± 3.84), and 6 months (84.23 ± 3.13 vs 77.29 ± 4.95) after surgery (P < 0.001). The FIM score was significantly higher in the telerehabilitation group than in the telephone group at 1 month (89.00 ± 5.63 vs 73.35 ± 8.70), 3 months (100.16 ± 4.56 vs 92.81 ± 5.17), and 6 months (111.70 ± 3.13 vs 98.64 ± 5.12) after surgery (P < 0.001). The SAS score was significantly lower in the telerehabilitation group than in the telephone group at 1 month (42.40 ± 3.07 vs 46.21 ± 3.53), 3 months (36.77 ± 2.26 vs 40.24 ± 1.66), and 6 months (29.26 ± 1.63 vs 33.81 ± 2.62) after surgery (P < 0.001). The overall complication rate was significantly lower in the telerehabilitation group than in the telephone group (14% vs 40.5%) (P < 0.05). CONCLUSION Internet-based rehabilitation management system can not only promote the physical rehabilitation of patients, but also play a positive role in psychological rehabilitation and the prevention of complications, which provides new ideas and methods for clinical rehabilitation.
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Affiliation(s)
- Wei‐yong Wu
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | | | | | - Bing Peng
- Department of OrthopaedicsTianjin HospitalTianjinChina
| | - Wei‐guo Xu
- Department of OrthopaedicsTianjin HospitalTianjinChina
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Richter JG, Chehab G, Reiter J, Aries P, Muehlensiepen F, Welcker M, Acar H, Voormann A, Schneider M, Specker C. Evaluation of the use of video consultation in German rheumatology care before and during the COVID-19 pandemic. Front Med (Lausanne) 2022; 9:1052055. [PMID: 36507506 PMCID: PMC9732003 DOI: 10.3389/fmed.2022.1052055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background The COVID-19 pandemic led to transformations in healthcare infrastructures and increased use of (innovative) telemedicine (TM) tools. Comparison of the use of video consultation (VC) in rheumatology in the pre-pandemic period and during the pandemic might allow for evaluating this new form of consultancy in healthcare due to changing conditions and possibilities. Materials and methods Cross-sectional nationwide online survey among German rheumatologists and rheumatologists in training between March and May 2021 promoted by newsletters and Twitter posts. Results Results refer to 205 participants. The majority was male (59%), older than 40 years (90%). Thirty-eight percent stated to have employed TM before ("digital users"), 27% were using VC as part of their TM expertise ("VC-users"), 10% stated to have experience with TM but not VC ("TM-users"). Those negating the use of any TM (62%) were designated as "digital non-users." TM-Knowledge was self-rated as 4 [median on a Likert Scale 1 (very high) to 6 (very low)] with a significant difference between digital users (VC-user 2.7 ± 1.2, TM-user 3.2 ± 1.1) and digital non-users (4.4 ± 1.3). The reported significant increase of VC use during the lockdown periods and between the lockdowns compared to the pre-pandemic phase was regarded as a proxy for VC acceptance in the pandemic. Reasons for VC non-use were administrative/technical efforts (21%), lack of technical equipment (15%), time constraints (12%), time required for individual VC sessions (12%), inadequate reimbursement (11%), lack of demand from patients (11%), data security concerns (9%), poor internet connection (8%), and lack of scientific evaluation/evidence (5%). Physicians considered the following clinical situations to be particularly suitable for VC: follow-up visits (VC-user 79%, TM-user 62%, digital non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, digital non-user 20%), and patients presenting for the first time (VC-user 11%, TM-user 19%, digital non-user 8%). Conclusion Even though the pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms as VC, its use and acceptance remained comparatively low due to multiple reasons. This analysis may help identify hurdles in employing innovative digital care models for rheumatologic healthcare.
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Affiliation(s)
- Jutta G. Richter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany,*Correspondence: Jutta G. Richter,
| | - Gamal Chehab
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Joana Reiter
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Welcker
- MVZ für Rheumatologie Dr. Martin Welcker GmbH and RheumaDatenRhePort (rhadar), Planegg, Germany
| | - Hasan Acar
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | | | - Matthias Schneider
- Policlinic for Rheumatology and Hiller Research Unit for Rheumatology, Medical Faculty, Heinrich Heine University Düsseldorf (HHUD), University Clinic, Düsseldorf, Germany
| | - Christof Specker
- Department of Rheumatology and Clinical Immunology, KEM Kliniken Essen-Mitte, Essen, Germany
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28
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Danila MI, Sun D, Jackson LE, Cutter G, Jackson EA, Ford EW, DeLaney E, Mudano A, Foster PJ, Rosas G, Melnick JA, Curtis JR, Saag KG. Satisfaction with modes of telemedicine delivery during COVID-19: A randomized, single-blind, parallel group, noninferiority trial. Am J Med Sci 2022; 364:538-546. [PMID: 35793732 PMCID: PMC9446840 DOI: 10.1016/j.amjms.2022.06.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/09/2022] [Accepted: 06/28/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Little is known about satisfaction with different modes of telemedicine delivery. The objective of this study was to determine whether patient satisfaction with phone-only was noninferior to video visits. METHODS We conducted a parallel group, randomized (1:1), single-blind, noninferiority trial in multispecialty clinics at a tertiary academic medical center. Adults age ≥ 60 years or with Medicare/Medicaid insurance were eligible. Primary outcome was visit satisfaction rate (9 or 10 on a 0-10 satisfaction scale). Noninferiority was determined if satisfaction with phone-only (intervention) versus video visits (comparator) was no worse by a -15% prespecified noninferiority margin. We performed modified intent-to-treat (mITT) and per protocol analyses, after adjusting for age and insurance. RESULTS 200 participants, 43% Black, 68% women completed surveys. Visit satisfaction rates were high. In the mITT analysis, phone-only visits were noninferior by an adjusted difference of 3.2% (95% CI, -7.6% to 14%). In the per protocol analysis, phone-only were noninferior by an adjusted difference of -4.1% (95% CI, -14.8% to 6.6%). The proportion of participants who indicated they preferred the same type of telemedicine visit as their next clinic visit were similar (30.2% vs 27.9% video vs phone-only, p = 0.78) and a majority said their medical concerns were addressed and would recommend a telemedicine visit. CONCLUSIONS Among a group of diverse, established older or underserved patients, the satisfaction rate for phone-only was noninferior to video visits. These findings could impact practice and policies governing telemedicine.
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Affiliation(s)
- Maria I Danila
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham VA Medical Center, Birmingham, AL, USA.
| | - Dongmei Sun
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lesley E Jackson
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Gary Cutter
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth A Jackson
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eric W Ford
- Department of Healthcare Organization and Policy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Erin DeLaney
- Department of Family and Community Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Amy Mudano
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Phillip J Foster
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Giovanna Rosas
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Joshua A Melnick
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey R Curtis
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kenneth G Saag
- Department of Medicine, Division of Clinical Immunology and Rheumatology University of Alabama at Birmingham, Birmingham, AL, USA
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Bernard L, Valsecchi V, Mura T, Aouinti S, Padern G, Ferreira R, Pastor J, Jorgensen C, Mercier G, Pers YM. Management of patients with rheumatoid arthritis by telemedicine: connected monitoring. A randomized controlled trial. Joint Bone Spine 2022; 89:105368. [PMID: 35248737 DOI: 10.1016/j.jbspin.2022.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/12/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Rheumatoid arthritis (RA) is a prevalent and disabling disease that is the source of significant direct and indirect costs. The current recommended therapeutic strategy is based on the rapid introduction of therapy with conventional Disease-Modifying Anti-Rheumatic Drugs (DMARDs) combined with regular disease monitoring by the rheumatologist. The onerous nature of such intense monitoring has motivated the development of new, less demanding strategies such as telemedicine. This study aimed to estimate the cost-effectiveness of the connected monitoring of RA patients initiating a new DMARD therapy versus conventional monitoring. METHODS An economic evaluation based on a randomized controlled trial of 89 patients was conducted. The patients in the intervention group (n=45) were monitored using a connected monitoring interface on a smartphone, while patients in the control group (n=44) were conventionally monitored. Health outcomes were measured as the gain in quality-adjusted life-years (QALYs), assessed using the EuroQol-5D questionnaire. Resource use and health outcomes were collected alongside the trial and at the six-month follow-up using application data and the related clinical case manager time, visits, hospitalisations, and transport records. These outcomes were valued using externally collected data on unit costs and QALY weights. RESULTS Compared to conventionally monitored patients, patients receiving connected monitoring had a slightly greater but not significant gain in the average QALY of 0.07. The economic analysis found that connected monitoring resulted in a significant cost reduction of 72€ (2927€ vs. 2999€, P<0.01). The incremental cost-utility ratio of the intervention was equal to -1,029€ per QALY (95% CI: -32,033; +24,625) with a 97.8% chance of being cost-effective at a threshold of 30,000€ per QALY gained. CONCLUSION Implementing EULAR recommendations for RA patients initiating a DMARD treatment using connected monitoring is more efficient and less expensive than conventional care. CLINICAL TRIAL REGISTRATION NUMBER ClinicalTrials.gov (NCT03005925).
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Affiliation(s)
- Laurene Bernard
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Verushka Valsecchi
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Thibault Mura
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Safa Aouinti
- Clinical Research and Epidemiology Unit (URCE), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Guillaume Padern
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Rosanna Ferreira
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Jenica Pastor
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Christian Jorgensen
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France
| | - Grégoire Mercier
- Clinical Research and Medico economic Unit (URME), CHU Montpellier, University of Montpellier, Montpellier, France
| | - Yves-Marie Pers
- IRMB, University of Montpellier, Inserm U1183, CHU Montpellier, Montpellier, France.
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Digital Rehabilitation for Elbow Pain Musculoskeletal Conditions: A Prospective Longitudinal Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159198. [PMID: 35954555 PMCID: PMC9367806 DOI: 10.3390/ijerph19159198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/20/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
Elbow musculoskeletal pain (EP) is a major cause of disability. Telerehabilitation has shown great potential in mitigating musculoskeletal pain conditions, but EP is less explored. This single-arm interventional study investigates clinical outcomes and engagement levels of a completely remote multimodal digital care program (DCP) in patients with EP. The DCP consisted of exercise, education, and cognitive-behavioral therapy for 8 weeks. Primary outcome: disability change (through the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), treatment response cut-offs: 12.0-point reduction and 30% change). Secondary outcomes: pain, analgesic intake, surgery intent, mental health, fear–avoidance beliefs, work productivity, and patient engagement. Of the 132 individuals that started the DCP, 112 (84.8%) completed the intervention. Significant improvements were observed in QuickDASH with an average reduction of 48.7% (11.9, 95% CI 9.8; 14.0), with 75.3% of participants reporting ≥30% change and 47.7% reporting ≥12.0 points. Disability change was accompanied by reductions in pain (53.1%), surgery intent (57.5%), anxiety (59.8%), depression (68.9%), fear–avoidance beliefs (34.2%), and productivity impairment (72.3%). Engagement (3.5 (SD 1.4) sessions per week) and satisfaction 8.5/10 (SD 1.6) were high. The significant improvement observed in clinical outcomes, alongside high engagement, and satisfaction suggests patient acceptance of this care delivery mode.
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022. [DOI: 10.1007/s12325-021-01990-6
expr 982114691 + 941296860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Jackson LE, Edgil TA, Hill B, Owensby JK, Smith CH, Singh JA, Danila MI. Telemedicine in Rheumatology Care: A Systematic Review. Semin Arthritis Rheum 2022; 56:152045. [DOI: 10.1016/j.semarthrit.2022.152045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
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Schreiber S, Ben-Horin S, Alten R, Westhovens R, Peyrin-Biroulet L, Danese S, Hibi T, Takeuchi K, Magro F, An Y, Kim DH, Yoon S, Reinisch W. Perspectives on Subcutaneous Infliximab for Rheumatic Diseases and Inflammatory Bowel Disease: Before, During, and After the COVID-19 Era. Adv Ther 2022; 39:2342-2364. [PMID: 34988877 PMCID: PMC8731678 DOI: 10.1007/s12325-021-01990-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 11/05/2021] [Indexed: 12/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has prompted significant changes in patient care in rheumatology and gastroenterology, with clinical guidance issued to manage ongoing therapy while minimising the risk of nosocomial infection for patients and healthcare professionals (HCPs). Subcutaneous (SC) formulations of biologics enable patients to self-administer treatments at home; however, switching between agents may be undesirable. CT-P13 SC is the first SC formulation of infliximab that received regulatory approval and may be termed a biobetter as it offers significant clinical advantages over intravenous (IV) infliximab, including improved pharmacokinetics and a convenient mode of delivery. Potential benefits in terms of reduced immunogenicity have also been suggested. With a new SC formulation, infliximab provides an additional option for dual formulation, which enables patients to transition from IV to SC administration route without changing agent. Before COVID-19, clinical trials supported the efficacy and safety of switching from IV to SC infliximab for patients with rheumatoid arthritis and inflammatory bowel disease (IBD), and SC infliximab may have been selected on the basis of patient and HCP preferences for SC agents. During the pandemic, patients with rheumatic diseases and IBD have successfully switched from IV to SC infliximab, with some clinical benefits and high levels of patient satisfaction. As patients switched to SC therapeutics, the reduction in resource requirements for IV infusion services may have been particularly welcome given the pandemic, facilitating reorganisation and redeployment in overstretched healthcare systems, alongside pharmacoeconomic benefits and a reduction in exposure to nosocomial infection. Telemedicine and contactless healthcare have been pushed to the forefront during the pandemic, and a lasting shift towards remote patient management and community/home-based drug administration is anticipated. SC infliximab supports the implementation of this paradigm for future improvements of healthcare value delivered. The accumulation of real-world data during the pandemic supports the high level of confidence, with patients, physicians, and healthcare systems benefitting from its uptake.
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Affiliation(s)
- Stefan Schreiber
- Department of Medicine I, Christian-Albrechts-University, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Shomron Ben-Horin
- Gastroenterology Department, Sheba Medical Center, Tel Aviv University, Tel-Hashomer, Israel
| | - Rieke Alten
- Department of Internal Medicine II, Rheumatology, Clinical Immunology, Osteology, Schlosspark Klinik, University Medicine Berlin, Berlin, Germany
| | - René Westhovens
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandoeuvre-les-Nancy, France
- Inserm U1256 NGERE, Lorraine University, Vandoeuvre-les-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Toshifumi Hibi
- Center for Advanced IBD Research and Treatment, Kitasato Institute Hospital, Kitasato University, Tokyo, Japan
| | - Ken Takeuchi
- Department of Gastroenterology, IBD Center, Tsujinaka Hospital Kashiwanoha, Chiba, Japan
| | - Fernando Magro
- Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal
- Department of Gastroenterology, Centro Hospitalar São João, Porto, Portugal
- MedInUP, Centre for Drug Discovery and Innovative Medicines, Porto, Portugal
| | - Yoorim An
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Dong-Hyeon Kim
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - SangWook Yoon
- Celltrion Healthcare Co., Ltd, Incheon, Republic of Korea
| | - Walter Reinisch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Hofer F, Schreyögg J, Stargardt T. Effectiveness of a home telemonitoring program for patients with chronic obstructive pulmonary disease in Germany: Evidence from the first three years. PLoS One 2022; 17:e0267952. [PMID: 35551546 PMCID: PMC9098037 DOI: 10.1371/journal.pone.0267952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Chronic obstructive pulmonary disease (COPD) affects more than 6 million people in Germany. Monitoring the vital parameters of COPD patients remotely through telemonitoring may help doctors and patients prevent and treat acute exacerbations of COPD, improving patients’ quality of life and saving costs for the statutory health insurance system. Objective To evaluate the effects from October 2012 until December 2015 of a structured home telemonitoring program implemented by a statutory health insurer in Germany. Methods We conducted a retrospective cohort study using administrative data. After building a balanced control group using Entropy Balancing, we calculated difference-in-difference estimators to account for time-invariant heterogeneity. We estimated differences in mortality rates using Cox regression and conducted subgroup and sensitivity analyses to check the robustness of the base case results. We observed each patient in the program for up to 3 years depending on his or her time of enrolment. Results Among patients in the telemonitoring cohort, we observed significantly higher inpatient costs due to COPD (€524.2, p<0,05; €434.6, p<0.05) and outpatient costs (102.5, p<0.01; 78.8 p<0.05) during the first two years of the program. Additional cost categories were significantly increased during the first year of telemonitoring. We also observed a significantly higher number of drug prescriptions during all three years of the observation period (2.0500, p < 0.05; 0.7260, p < 0.05; 3.3170, p < 0.01) and a higher number of outpatient contacts during the first two years (0.945, p<0.01, 0.683, p<0.05). Furthermore, we found significantly improved survival rates for participants in the telemonitoring program (HR 0.68, p<0.001). Conclusion On one hand, telemonitoring was associated with higher health care expenditures, especially in the first year of the program. For example, we were able to identify a statistically significant increase in inpatient costs due to COPD, outpatient contacts and drug prescriptions among individuals participating in the telemonitoring program. On the other hand, the telemonitoring program was accompanied by a survival benefit, which might be related to higher adherence rates, more intense treatment, or an improved understanding of COPD among these patients.
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Affiliation(s)
- Florian Hofer
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Hamburg, Germany
| | - Tom Stargardt
- Hamburg Center for Health Economics (HCHE), Universität Hamburg, Hamburg, Germany
- * E-mail:
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Marques A, Bosch P, de Thurah A, Meissner Y, Falzon L, Mukhtyar C, Bijlsma JW, Dejaco C, Stamm TA. Effectiveness of remote care interventions: a systematic review informing the 2022 EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases. RMD Open 2022; 8:rmdopen-2022-002290. [PMID: 35523520 PMCID: PMC9083395 DOI: 10.1136/rmdopen-2022-002290] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 04/21/2022] [Indexed: 12/14/2022] Open
Abstract
Objective To perform a systematic literature review (SLR) on different outcomes of remote care compared with face-to-face (F2F) care, its implementation into clinical practice and to identify drivers and barriers in order to inform a task force formulating the EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases (RMDs). Methods A search strategy was developed and run in Medline (PubMed), Embase and Cochrane Library. Two reviewers independently performed standardised data extraction, synthesis and risk of bias (RoB) assessment. Results A total of 2240 references were identified. Forty-seven of them fulfilled the inclusion criteria. Remote monitoring (n=35) was most frequently studied, with telephone/video calls being the most common mode of delivery (n=30). Of the 34 studies investigating outcomes of remote care, the majority addressed efficacy and user perception; 34% and 21% of them, respectively, reported a superiority of remote care as compared with F2F care. Time and cost savings were reported as major benefits, technical aspects as major drawback in the 13 studies that investigated drivers and barriers of remote care. No study addressed remote care implementation. The main limitation of the studies identified was the heterogeneity of outcomes and methods, as well as a substantial RoB (50% of studies with high RoB). Conclusions Remote care leads to similar or better results compared with F2F treatment concerning efficacy, safety, adherence and user perception outcomes, with the limitation of heterogeneity and considerable RoB of the available studies.
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Affiliation(s)
- Andréa Marques
- Higher School of Nursing of Coimbra Health Sciences Research Unit Nursing, Coimbra, Portugal .,Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Philipp Bosch
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Annette de Thurah
- Rheumatology, Aarhus University Hospital, Århus N, Denmark.,Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Yvette Meissner
- Epidemiology and Health Services Research, German Rheumatism Research Centre, Berlin, Germany
| | - Louise Falzon
- Health Economics and Decision Science, The University of Sheffield, Sheffield, UK
| | - Chetan Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Johannes Wj Bijlsma
- Rheumatology, University Medical Center Utrecht Department of Rheumatology and Clinical Immunology, Utrecht, The Netherlands
| | - Christian Dejaco
- Rheumatology, Medical University of Graz, Graz, Austria.,Rheumatology, Hospital of Bruneck, Bruneck, Italy
| | - Tanja A Stamm
- Section for Outcomes Research, Medical University of Vienna, Vienna, Austria
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Factors affecting patient satisfaction with outpatient rheumatology phone visits during the COVID-19 pandemic. Clin Rheumatol 2022; 41:2839-2844. [PMID: 35513759 PMCID: PMC9071247 DOI: 10.1007/s10067-022-06182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/17/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
The aim was to evaluate patient satisfaction with virtual care, and identify factors associated with level of satisfaction. Surveys were mailed to all patients who had a phone visit at The Ottawa Hospital Rheumatology division. Patients' satisfaction with various aspects of the phone visits was assessed on a 5-point scale and analyzed according to demographic variables using chi-square and regression analyses. Of 2423 surveys mailed, we received 742 responses (31%). Eighty-nine percent of patients were satisfied overall with the phone visit. Statistically significant less satisfaction was seen in patients who spoke to a resident compared to their rheumatologist (p < 0.001), were not called on time (p < 0.001), had difficulty using a telephone (p < 0.001), needed assistance of a second person (p < 0.01), or had new consultations (versus routine follow-up, p = 0.01), the former 3 factors being significant in a multivariate regression analysis. Rheumatology patients expressed a high level of satisfaction with virtual care; however, areas of improvement were identified. Patients' satisfaction will be important to inform future decisions regarding the sustainability of virtual care. Further research is required to understand the impacts of virtual care on patients' Key Points • Patients in rheumatology practice were satisfied with phone visits and preferred this method to in-person visits during the pandemic. • Speaking directly to the rheumatologist, being phoned on time, and the capability of using the telephone were the major determinants of high patient satisfaction. • Based on the identified factors, further improvement of the quality of and satisfaction with phone visits can be pursued given that virtual care may continue longer, beyond the pandemic.
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Abstract
PURPOSE OF REVIEW We summarize the recent literature published in the last 2 years on healthcare disparities observed in the delivery of rheumatology care by telemedicine. We highlight recent research dissecting the underpinnings of healthcare disparities and identify potentially modifiable contributing factors. RECENT FINDINGS The COVID-19 pandemic has had major impacts on care delivery and has led to a pronounced increase in telemedicine use in rheumatology practice. Telemedicine services are disproportionately underutilized by racial/ethnic minority groups and among patients with lower socioeconomic status. Disparities in telemedicine access and use among vulnerable populations threatens to exacerbate existing outcome inequalities affecting people with rheumatic disease. SUMMARY Telemedicine has the potential to expand rheumatology services by reaching traditionally underserved communities. However, some areas lack the infrastructure and technology to engage in telemedicine. Addressing health equity and the digital divide may help foster more inclusive telemedicine care.
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Affiliation(s)
- Lesley E Jackson
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rodríguez-Vargas GS, Nieto-Zambrano PD, Rubio-Rubio JA, Santos-Moreno P, Rojas-Villarraga A. Artritis reumatoide y telemedicina en tiempos de COVID-19. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
La artritis reumatoide es una afección autoinmune, crónica y multisistémica que requiere manejo multidisciplinar, siendo la supervisión continua fundamental para controlar su progresión. Tanto la artritis como el tratamiento generan un estado inmunosupresor que predispone a sufrir infecciones. Por la actual emergencia sanitaria ocasionada por el Sars-Cov2, los pacientes con estas enfermedades crónicas e inmunológicas son más susceptibles de contagio, por ello se ha requerido el uso de nuevas tecnologías como la telemedicina, que en los años previos a la pandemia venía incrementándose su uso, para permitir el control de patologías crónicas. El objetivo del presente estudio es revisar qué implicaciones ha tenido el uso de la telemedicina en el manejo de la artritis reumatoide durante la actual pandemia COVID-19 y cuál ha sido la importancia de la implementación de estas tecnologías en la enfermedad.
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Thurah AD, Marques A, Souza SD, Crowson CS, Myasoedova E. Future challenges in rheumatology – is telemedicine the solution? Ther Adv Musculoskelet Dis 2022; 14:1759720X221081638. [PMID: 35321119 PMCID: PMC8935581 DOI: 10.1177/1759720x221081638] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/26/2022] [Indexed: 12/14/2022] Open
Abstract
The COVID-19 pandemic has become an unprecedented facilitator of rapid telehealth expansion within rheumatology. Due to demographic shifts and workforce shortages in the future, new models of rheumatology care will be expected to emerge, with a growing footprint of telehealth interventions. Telehealth is already being used to monitor patients with rheumatic diseases and initial studies show good results in terms of safety and disease progression. It is being used as a tool for appointment prioritization and triage, and there is good evidence for using telehealth in rehabilitation, patient education and self-management interventions. Electronic patient-reported outcomes (ePROs) offer a number of long-term benefits and opportunities, and a routine collection of ePROs also facilitates epidemiological research that can inform future healthcare delivery. Telehealth solutions should be developed in close collaboration with all stakeholders, and the option of a telehealth visit must not deprive patients of the possibility to make use of a conventional ‘face-to-face’ visit. Future studies should especially focus on optimal models for rheumatology healthcare delivery to patients living in remote areas who are unable to use or access computer technology, and other patient groups at risk for disparity due to technical inequity and lack of knowledge.
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Affiliation(s)
- Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8240, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Andrea Marques
- Health Sciences Research Unit: Nursing, Higher School of Nursing of Coimbra, Coimbra, Portugal
- Rheumatology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Savia de Souza
- Centre for Rheumatic Diseases, King’s College London, London, UK
| | - Cynthia S. Crowson
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Qualitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Internal Medicine, Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
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Telemedicine in the Management of Patients with Rheumatic Disease during COVID-19 Pandemic: Incidence of Psychiatric Disorders and Fibromyalgia in Patients with Rheumatoid Arthritis and Psoriatic Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063161. [PMID: 35328849 PMCID: PMC8956021 DOI: 10.3390/ijerph19063161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 12/17/2022]
Abstract
The management of patients with immuno-rheumatological diseases has profoundly changed during the COVID-19 pandemic and telemedicine has played an important role in the disease follow-up. In addition to monitoring disease activity and any adverse events, especially infectious events, assessing the psychological situation of the patient can be fundamental. Furthermore, COVID-19 has a serious impact on mental health and, since the beginning of the pandemic, a significantly higher incidence of anxiety disorders and depressive symptoms especially in younger people was observed. In this study, we evaluated the incidence of depressive disorders, anxiety, and fibromyalgia (FM) in our patients with rheumatoid arthritis and psoriatic arthritis during the lockdown period due to the COVID-19 pandemic and we validate the use of telemedicine in the clinical management of these patients. Mental and physical stress during the COVID-19 pandemic can greatly worsen FM symptoms and intensify patients’ suffering without a clinical flare of the inflammatory disease for patients affected by rheumatoid arthritis. Telemedicine has allowed us to identify patients who needed a face-to-face approach for therapeutic reevaluation even if not related to a flare of the inflammatory disease. Even if our data does not allow us to draw definitive conclusions regarding the effectiveness of telemedicine as greater than or equal to the standard face-to-face approach, we continue to work by modifying our approach to try to ensure the necessary care in compliance with safety and, optimistically, this tool will become an important part of rheumatic disease management.
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Jhaveri D, Emeto TI, Alele FO, Strom A, Benham H. Use of telemedicine for rheumatology practice in Queensland, Australia: Experiences before and during the COVID-19 pandemic. Intern Med J 2022; 52:1685-1690. [PMID: 35112769 DOI: 10.1111/imj.15706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/23/2022] [Accepted: 01/26/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Australia there is a shortage of rheumatologists potentially translating to poorer outcomes. A possible solution in this setting is telemedicine (TM). AIM The aim of this study was to examine the utilisation and provider perceptions of TM in rheumatology in Queensland and explore the challenges faced when using TM before and during COVID-19. METHODS A sequential mixed-methods study design was used. Rheumatologists completed a questionnaire on demographics, clinical practice, TM uptake, models of care and clinician perceptions of TM. The qualitative phase utilised purposeful sampling of active users of TM through in-depth semi-structured interviews. RESULTS Thirty rheumatologists participated with 76.7% identifying as active TM users. Use of TM was limited prior to COVID-19 with 80.9% seeing less than 5 patients per week. Patient populations served by TM included capital city (53.3%), regional (63.3%) and rural/remote (23.3%). Most rheumatologists prescribed conventional or biologic disease modifying agents (90% and 55%) through TM consultations. Barriers to TM use included low confidence in joint assessments, limited distribution of technology, access to administrative and peripheral clinical staff and lack of financial incentives. During the COVID-19 pandemic, a significant expansion of TM via telephone calls occurred and rheumatologists reported low confidence and satisfaction with this model. CONCLUSIONS Familiarity with TM exists in this rheumatologist cohort, however its use in routine practise is limited due to multiple barriers. The COVID 19 pandemic highlighted low confidence in telephone calls as a form of TM underlining the need for appropriate TM models of care for rheumatology practice. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Divita Jhaveri
- Rheumatology Department, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - Theophilus I Emeto
- Public Health & Tropical Medical, College of Public Health, Medical & Veterinary Sciences. James Cook University, Townsville, QLD, 4811, Australia
| | - Faith O Alele
- Public Health & Tropical Medical, College of Public Health, Medical & Veterinary Sciences. James Cook University, Townsville, QLD, 4811, Australia
| | - Aleisha Strom
- Internal Medicine Department, Townsville University Hospital, Angus Smith Dr, Douglas, QLD, 4811, Australia
| | - Helen Benham
- Rheumatology Department, Princess Alexandra Hospital, Ipswich Rd, Woolloongabba, QLD, 4102, Australia.,Faculty of Medicine, The University of Queensland, Herston, QLD, 4029, Australia
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Singh JA, Richards JS, Chang E, Joseph AM, Ng B. Telemedicine Use During the COVID-19 Pandemic by Resilient Rheumatology Providers: A National Veterans Affairs Follow-up Survey. J Rheumatol 2022; 49:424-431. [DOI: 10.3899/jrheum.210967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
Objective To assess rheumatology provider experience and practices at Veterans Affairs (VA) facilities during the COVID-19 pandemic. Methods We performed an anonymized follow-up national cross-sectional survey (11/2020-1/2021) to assess provider resilience, experience, practices, views, and opinions about changes to medications and laboratory monitoring of veterans with rheumatic disease. Results Of the 143 eligible VA rheumatology providers, 114 (80%) responded. Compared to the original survey, fewer providers reported using telephone visits, 91% vs. 78% (p =0.009), and more used clinical video telehealth (CVT), 7% vs. 16% (p=0.04) or in-person visits, 59% vs. 76% (p=0.007). Most providers were somewhat or very comfortable with the quality of clinical encounter for established but not new patients for telephone, video-based VA video connect (VVC), and CVT. The mean Connor-Davidson Resilience Scale ( CD-RISC2) score was 6.8 (SD, 1.11; range 0-8; higher=more resilient), significantly higher than the original April- May 2020 survey score of 6.35 (SD, 1.26; p=0.004). Adjusted for age, sex and ethnicity, high provider resilience was associated with significantly higher odds ratio (OR) of comfort with technology and the quality of the VVC visit: (1) established patient, 1.71 (95% CI, 0.67-4.40) and 4.13 (95% CI, 1.49-11.44); (2) new patient, 2.79 (95% CI, 1.11-7.05); and 2.69 (95% CI, 1.06-6.82), respectively. Conclusion Reassuringly, VA rheumatology providers became increasingly comfortable with video visits during the first 10 months of the pandemic. High provider resilience, and its association with better quality video visits, raise the possibility that video visits might be an acceptable substitute for in-person visits under appropriate circumstances.
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Bouma SE, van Beek JFE, Diercks RL, van der Woude LHV, Stevens M, van den Akker-Scheek I. Barriers and facilitators perceived by healthcare professionals for implementing lifestyle interventions in patients with osteoarthritis: a scoping review. BMJ Open 2022; 12:e056831. [PMID: 35105598 PMCID: PMC8808449 DOI: 10.1136/bmjopen-2021-056831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/07/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE To provide an overview of barriers and facilitators that healthcare professionals (HCPs) perceive regarding the implementation of lifestyle interventions (LIs) in patients with hip and/or knee osteoarthritis (OA). DESIGN Scoping review. DATA SOURCES The databases PubMed, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception up to January 2021. ELIGIBILITY CRITERIA Primary research articles with a quantitative, qualitative or mixed-methods design were eligible for inclusion if they reported: (1) perceptions of primary and/or secondary HCPs (population); (2) on implementing LIs with physical activity and/or weight management as key components (concept) and (3) on conservative management of hip and/or knee OA (context). Articles not published in English, German or Dutch were excluded. DATA EXTRACTION AND SYNTHESIS Barriers and facilitators were extracted by two researchers independently. Subsequently, the extracted factors were linked to a framework based on the Tailored Implementation for Chronic Diseases checklist. RESULTS Thirty-six articles were included. In total, 809 factors were extracted and subdivided into nine domains. The extracted barriers were mostly related to non-optimal interdisciplinary collaboration, patients' negative attitude towards LIs, patients' low health literacy and HCPs' lack of knowledge and skills around LIs or promoting behavioural change. The extracted facilitators were mostly related to good interdisciplinary collaboration, a positive perception of HCPs' own role in implementing LIs, the content or structure of LIs and HCPs' positive attitude towards LIs. CONCLUSIONS Multiple individual and environmental factors influence the implementation of LIs by HCPs in patients with hip and/or knee OA. The resulting overview of barriers and facilitators can guide future research on the implementation of LIs within OA care. To investigate whether factor frequency is related to the relevance of each domain, further research should assess the relative importance of the identified factors involving all relevant disciplines of primary and secondary HCPs. PROSPERO REGISTRATION NUMBER CRD42019129348.
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Affiliation(s)
- Sjoukje E Bouma
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Juliette F E van Beek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Lucas H V van der Woude
- Center for Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Barber CE, Levy DM, Ahluwalia V, Mendel A, Taylor-Gjevre R, Gerschman T, Koppikar S, Jilkine K, Stringer E, Barnabe C, Aydin SZ, Luca N, Berard R, Tam K, Burt J, Murdoch JC, Zinck G, Lane T, Heeley J, Mannerow M, Mills R, Wilhelm L, Spencer N, Ohata B. Best Practices for Virtual Care, a Consensus Statement from the Canadian Rheumatology Association. J Rheumatol 2022; 49:408-418. [DOI: 10.3899/jrheum.211017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 11/22/2022]
Abstract
Objective To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association's (CRA) Telehealth Working Group (TWG). Methods Four members of the TWG representing adult, pediatric, university-based and community rheumatology practices defined the scope of the project. A rapid literature review was conducted between April-May 2021 of existing systematic reviews, policy documents and published literature and abstracts on the topic. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set. Results 21 (95%) panelists participated in R1, 15 (71%) in R2 and 18 (82%) in R3. All but one statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex co-management of disease. Conclusion The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned.
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Telehealth in rheumatology: the 2021 Arab League of Rheumatology Best Practice Guidelines. Rheumatol Int 2022; 42:379-390. [PMID: 34993578 PMCID: PMC8735733 DOI: 10.1007/s00296-021-05078-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
To develop Best Practice Guidelines (BPG) for the use of Telehealth in Rheumatology in the Arab region, to identify the main barriers and facilitators of telehealth, and to provide rheumatologists with a practical toolkit for the implementation of telehealth. Guidelines were drafted by a core steering committee from the Arab League of Associations for Rheumatology (ArLAR) after performing a literature search. A multidisciplinary task force (TF), including 18 rheumatologists, 2 patients, and 2 regulators from 15 Arab countries, assessed the BPG using 3 rounds of anonymous online voting by modified Delphi process. The statements were included in the final BPG without further voting if ≥ 80% of TF members indicated high agreement. The voting on barriers and facilitators was performed through one voting round. The toolkit was developed based on available literature and discussions during the Delphi rounds. Four General Principles and twelve Statements were formulated. A teleconsultation was specifically defined for the purpose of these guidelines. The concept of choice in telehealth was highlighted, emphasizing patient confidentiality, medical information security, rheumatologist's clinical judgment, and local jurisdictional regulations. The top barrier for telehealth was the concern about the quality of care. The toolkit emphasized technical aspects of teleconsultation and proposed a triage system. The ArLAR BPG provide rheumatologists with a series of strategies about the most reliable, productive, and rational approaches to apply telehealth.
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Marques CDL, Ribeiro SLE, Albuquerque CP, de Sousa Studart SA, Ranzolin A, de Andrade NPB, Dantas AT, Mota GD, Resende GG, Marinho AO, Angelieri D, Andrade D, Ribeiro FM, Omura F, Silva NA, Rocha Junior L, Brito DE, Fernandino DC, Yazbek MA, Souza MPG, Ximenes AC, Martins ASS, Castro GRW, Oliveira LC, Freitas ABSB, Kakehasi AM, Gomides APM, Reis Neto ET, Pileggi GS, Ferreira GA, Mota LMH, Xavier RM, de Medeiros Pinheiro M. COVID-19 was not associated or trigger disease activity in spondylarthritis patients: ReumaCoV-Brasil cross-sectional data. Adv Rheumatol 2022; 62:45. [PMID: 36419163 PMCID: PMC9685130 DOI: 10.1186/s42358-022-00268-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). METHODS ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. RESULTS 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62-8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02-5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33-24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02-0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41-53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03-0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02-0.76; p = 0.02) remained at final model as protective factor. CONCLUSIONS Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.
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Affiliation(s)
| | | | | | | | | | - Nicole Pamplona Bueno de Andrade
- grid.8532.c0000 0001 2200 7498Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea T. Dantas
- grid.411227.30000 0001 0670 7996Hospital das Clínicas – Universidade Federal de Pernambuco, Recife, Brazil
| | - Guilherme D. Mota
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gustavo G. Resende
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Danielle Angelieri
- grid.414644.70000 0004 0411 4654Hospital dos Servidores de São Paulo – IAMSPE, São Paulo, Brazil
| | - Danieli Andrade
- grid.11899.380000 0004 1937 0722Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Francinne M. Ribeiro
- grid.412211.50000 0004 4687 5267Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Abraão, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | - Nilzio A. Silva
- grid.411195.90000 0001 2192 5801Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brazil
| | - Laurindo Rocha Junior
- grid.419095.00000 0004 0417 6556Instituto de Medicina Integral Professor Fernando Figueira -IMIP, Recife, Brazil
| | - Danielle E. Brito
- grid.411216.10000 0004 0397 5145Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Diana C. Fernandino
- grid.411198.40000 0001 2170 9332Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Michel A. Yazbek
- grid.411087.b0000 0001 0723 2494Hospital de Clínicas da Universidade Estadual de Campinas- UNICAMP, Campinas, Brazil
| | - Mariana P. G. Souza
- grid.415169.e0000 0001 2198 9354Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Ana Silvia S. Martins
- grid.411284.a0000 0004 4647 6936Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Glaucio Ricardo W. Castro
- grid.413214.10000 0004 0504 2293Hospital Governador Celso Ramos – Santa Catarina, Florianópolis, Brazil
| | | | | | - Adriana M. Kakehasi
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Edgard Torres Reis Neto
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gecilmara S. Pileggi
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gilda A. Ferreira
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Licia Maria H. Mota
- grid.7632.00000 0001 2238 5157Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (PPGCM-FM-UnB), Brazil, Brasília, DF Brazil ,grid.411215.2Hospital Universitário de Brasília (HUB-UnB-EBSERH), Brasília, DF Brazil
| | - Ricardo M. Xavier
- grid.8532.c0000 0001 2200 7498Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo de Medeiros Pinheiro
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
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Pediatric subspecialty telemedicine use from the patient and provider perspective. Pediatr Res 2022; 91:241-246. [PMID: 33753896 PMCID: PMC7984505 DOI: 10.1038/s41390-021-01443-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND To characterize telemedicine use among pediatric subspecialties with respect to clinical uses of telemedicine, provider experience, and patient perceptions during the COVID-19 pandemic. METHODS We performed a mixed-methods study of telemedicine visits across pediatric endocrinology, nephrology, orthopedic surgery, and rheumatology at a large children's hospital. We used deductive analysis to review observational data from 40 video visits. Providers and patients/caregivers were surveyed around areas of satisfaction and communication. RESULTS We found adaptations of telemedicine including shared-screen use and provider-guided parent procedures among others. All providers felt that it was safest for their patients to conduct visits by video, and 72.7% reported completing some component of a clinical exam. Patients rated the areas of being respected by the clinical staff/provider and showing care and concern highly, and the mean overall satisfaction was 86.7 ± 19.3%. CONCLUSIONS Telemedicine has been used to deliver care to pediatric patients during the pandemic, and we found that patients were satisfied with the telemedicine visits during this stressful time and that providers were able to innovate during visits. Telemedicine is a tool that can be successfully adapted to patient and provider needs, but further studies are needed to fully explore its integration in pediatric subspecialty care. IMPACT This study describes telemedicine use at the height of the COVID-19 pandemic from both a provider and patient perspective, in four different pediatric subspecialties. Prior to COVID-19, pediatric telehealth landscape analysis suggested that many pediatric specialty practices had pilot telehealth programs, but there are few published studies evaluating telemedicine performance through the simultaneous patient and provider experience as part of standard care. We describe novel uses and adaptations of telemedicine during a time of rapid deployment in pediatric specialty care.
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Gifford AH, Ong T, Dowd C, Van Citters AD, Scalia P, Sabadosa KA, Sawicki GS. Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at U.S. cystic fibrosis programs. J Cyst Fibros 2021; 20 Suppl 3:9-13. [PMID: 34930545 PMCID: PMC8683125 DOI: 10.1016/j.jcf.2021.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 08/29/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) care programs in the United States rapidly adopted telehealth during the COVID-19 pandemic. Understanding factors that promote or impede telehealth will inform planning for future telehealth-enabled care models. METHODS Adult, pediatric, and affiliate CF care programs in the United States (n = 287) were surveyed twice eight months apart in 2020-2021 about telehealth use. Programs were asked to describe barriers to and promoters of telehealth. RESULTS Ninety-seven percent of programs provided telehealth services. In the first CF Care Program State of Care Survey (SoC1), programs estimated that 57% of patients exclusively received in-person care, 36% of patients received telehealth by phone/computer with video, and 8% of patients received telephone-only care. In the second CF Care Program State of Care Survey (SoC2), programs estimated that 80% of visits were in-person and 15% were via audio and video telehealth. Pediatric programs (21%) were less likely than adult (37%) or affiliate (41%) programs to recommend telehealth (p = 0.007). All programs ranked lack of internet access as the highest barrier to patient engagement with telehealth. Promoters of telehealth were increased accessibility and avoidance of infection transmission. Top ranked changes to improve telehealth were expanded provision of remote monitoring devices and technology access. Similar proportions of program types anticipated institutional telehealth expansion. CONCLUSION During the COVID-19 pandemic, CF programs in the United States identified factors to improve future care delivery via telehealth. Targeting specific barriers and promoters will improve the use and quality of telehealth throughout the care center network.
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Affiliation(s)
- Alex H Gifford
- Pulmonary Critical Care and Sleep Medicine, University Hospitals, Cleveland, OH, USA.
| | - Thida Ong
- Pediatric Pulmonology, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Aricca D Van Citters
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Peter Scalia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Gregory S Sawicki
- Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA, USA
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Muehlensiepen F, Knitza J, Marquardt W, May S, Krusche M, Hueber A, Schwarz J, Vuillerme N, Heinze M, Welcker M. Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413127. [PMID: 34948737 PMCID: PMC8701397 DOI: 10.3390/ijerph182413127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.
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Affiliation(s)
- Felix Muehlensiepen
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Correspondence:
| | - Johannes Knitza
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Wenke Marquardt
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
| | - Susann May
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
| | - Martin Krusche
- Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Axel Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, 90419 Nürnberg, Germany;
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Institut Universitaire de France, 75006 Paris, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38400 Grenoble, France
| | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, 82152 Planegg, Germany;
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Rodríguez-Fernández JM, Danies E, Hoertel N, Galanter W, Saner H, Franco OH. Telemedicine Readiness Across Medical Conditions in a US National Representative Sample of Older Adults. J Appl Gerontol 2021; 41:982-992. [PMID: 34855553 DOI: 10.1177/07334648211056231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Telemedicine has provided older adults the ability to seek care remotely during the coronavirus disease (COVID-19) pandemic. However, it is unclear how diverse medical conditions play a role in telemedicine uptake. A total of 3379 participants (≥65 years) were interviewed in 2018 as part of the National Health and Aging Trends Study. We assessed telemedicine readiness across multiple medical conditions. Most chronic medical conditions and mood symptoms were significantly associated with telemedicine unreadiness, for physical or technical reasons or both, while cancer, hypertension, and arthritis were significantly associated with telemedicine readiness. Our findings suggest that multiple medical conditions play a substantial role in telemedicine uptake among older adults in the US. Therefore, comorbidities should be taken into consideration when promoting and adopting telemedicine technologies among older adults.
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Affiliation(s)
| | | | - Nicolas Hoertel
- 26930AP-HP. Centre-Université de Paris, Hôpital Corentin-Celton, DMU Psychiatrie et Addictologie, Issy-les-Moulineaux, France.,INSERM, Institut de Psychiatrie et Neurosciences de Paris, UMR_S1266, Paris, France.,Université de Paris, Faculté de Santé, UFR de Médecine, Paris, France
| | | | - Hugo Saner
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine (ISPM), 30317University of Bern, Bern, Switzerland
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