Healthcare utilization and unmet needs of patients with antisynthetase syndrome: An international patient survey

Antisynthease syndrome (ASSD) is a rare, complex and understudied autoimmune disease. Internet-based studies can overcome barriers of traditional on-site research and are therefore very appealing for rare diseases. The aim of this study was to investigate patient-reported symptoms, diagnostic delay, symptoms, medical care, health status, working status, disease knowledge and willingness to participate in research of ASSD patients by conducting an international web-based survey. The multilingual questionnaire was created by an international group of rheumatologists and patients and distributed online. 236 participants from 22 countries completed the survey. 184/236 (78.0%) were female, mean age (SD) was 49.6 years (11.3) and most common antisynthetase antibody was Jo-1 (169/236, 71.6%). 79/236 (33.5%) reported to work full-time. Median diagnostic delay was one year. The most common symptom at disease onset was fatigue 159/236 (67.4%), followed by myalgia 130/236 (55.1%). The complete triad of myositis, arthritis and lung involvement verified by a clinician was present in 42/236 (17.8%) at disease onset and in 88/236 (37.3%) during the disease course. 36/236 (15.3%) reported to have been diagnosed with fibromyalgia and 40/236 (16.3%) with depression. The most reported immunosuppressive treatments were oral corticosteroids 179/236 (75.9%), followed by rituximab 85/236 (36.0%). 73/236 (30.9%) had received physiotherapy treatment. 71/236 (30.1%) reported to know useful online information sources related to ASSD. 223/236 (94.5%) were willing to share health data for research purposes once a year. Our results reiterate that internet-based research is invaluable for cooperating with patients to foster knowledge in rare diseases.

POS0378 EVALUATION OF THE USE OF VIDEO CONSULTATION IN GERMAN RHEUMATOLOGY CARE BEFORE AND DURING THE COVID-19 PANDEMIC WAVES

Background

During the COVID-19 pandemic telemedicine tools rapidly and widely gained acceptance as indispensable management tools for the continuum of clinical care in rheumatic diseases. They have been adopted in position papers and guidelines for the management of rheumatic diseases in adult patients.

Objectives

Evaluation of the use of video consultation as one form of telemedicine before and during the COVID-19 pandemic and associated lockdowns among Rheumatology physicians in Germany. The survey results are expected to support the optimization and implementation of video consultation (VC) into routine clinical practice in rheumatology, providing long-term benefits for both parties, patients and their treating rheumatologists.

Methods

Cross-sectional nationwide online survey among German rheumatologists and rheumatologists in training. The survey was promoted by newsletters sent by means of mail and Twitter posts to members of the German Society for Rheumatology (n=1,650) and German Professional Society for Rheumatology (n=527).

Results

Reported data refer to 205 participants. The majority of respondents was male (59%), older than 40 years (90%) and specialized in internal medicine/rheumatology (85%).

They were divided into two groups: ‘digital users’ (38%) and ‘digital non-users’ (62%). Users employing telemedicine (TM) but never VC were defined as ‘TM-users’ (10%). Those using TM and VC were classified as ‘VC-users’ (27%). ‘Non-users’ negated the use of VC and TM respectively.

Knowledge on telemedicine was self-rated as 4 (median on a Likert Scale 1 (very high) to 6 (very low)) with a significant difference between user (VC-user 2.7±1.2, TM-user 3.2±1.1) and non-user (4.4±1.3).

The Figure 1 shows a significant increase in the use of VC during the lockdown periods. Even between the lockdown phases, VC use was higher than in the pre-pandemic phase.

Figure 1.

Grouped patient numbers seen via VC during the pandemic waves

Reasons for VC non-use in TM-user and non-user 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%).

Based on the experience gained, physicians considered the following clinical situations to be particularly suitable for VC: follow-up visits (VC-user 79%, TM-user 62%, non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, non-user 20%), and patients presenting for the first time (VC-user 11%, TM-user 19%, non-user 8%).

Table 1.

Evaluation of the VC in comparison to other patient interaction (VC-user) on a Likert Scale with 1 (I agree completely) to 6 (I do not agree at all)

VC isMean ± standard deviation (median)… comparable to a face to face meeting (n=52)4.3 ± 1.3 (4.5)… comparable to a telephone consultation (n=51)3.3 ± 1.3 (3.0)… suitable as an additional means of communication with the patient (n=51)2.3 ± 1.5 (2.0)

Conclusion

Despite the fact that the current pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms such as VC, their use and acceptance remained below expectations. Given the reported decline in physician face-to-face consultations during the pandemic, these findings are even more concerning. The identified reasons for non-utilization should be addressed by policy makers, payers and medical societies to provide better foundations for future innovative care models.

Disclosure of Interests

Joana Reiter: None declared, Gamal Chehab: None declared, Peer Aries: None declared, Felix Muehlensiepen Speakers bureau: Novartis Pharma GmbH, Grant/research support from: Novartis Pharma GmbH & AbbVie Deutschland GmbH & Co. KG, Martin Welcker: None declared, Anna Voormann: None declared, Matthias Schneider Speakers bureau: Astra-Zeneca; Biogen; BMS; Celgene; Chugai; GSK; Janssen-Cilag; Lilly; Pfizer; UCB, Paid instructor for: Lilly, Consultant of: Abbvie; Astra-Zeneca; Boehringer-Ingelheim; GSK; Lilly; Novartis; Pfizer; Protagen; Roche; Sanofi-Aventis; UCB, Grant/research support from: Abbvie; Astra-Zeneca; GSK; UCB, Christof Specker: None declared, Jutta G. Richter: None declared

AB1348-HPR TELEMEDICINE IN RHEUMATOLOGY: ACCEPTANCE BY PATIENTS AND MEDICAL PRACTITIONERS IN GERMANY (TELERHEUMABB) - INTERIM ANALYSIS

Background:

The number of rheumatologists in Germany does not cover the minimum medical need [1]. This implies long journeys and waiting periods for patients in the context of rheumatologists’ consultations. International studies suggest that telemedicine could resolve these issues and support health care professionals in rheumatologic care [2, 3]. So far, comprehensive sustainable approaches are still pending in Germany. By addressing the potential users, TeleRheumaBB investigates whether and how telemedicine can support rheumatologic care in Germany. The study is realized from Oct. 2017 until Jun. 2020.

Objectives:

The objectives of the study are to evaluate the acceptance and willingness of patients and medical practitioners (MP) to implement telemedicine into rheumatological care as well as to understand how telemedical approaches should be designed to be applied in daily practice.

Methods:

The study design contains a mixed-methods approach, which combines qualitative and quantitative data. In the qualitative part of the study 28 in-depth interviews and 3 focus groups involving patients, rheumatologists, general practitioners and stakeholders were conducted. The quantitative part of the study comprised a questionnaire survey with rheumatologists (n=48) and referrers (n=444) and a second questionnaire survey with patients (n=734).

Results:

Qualitative Data:

The term “telemedicine” is filled with different meanings. Motives to implement telemedicine into daily practice are patient guidance, information, substantial time savings, desire of a modern practice etc. Reported risks of telemedicine are adverse impacts on the doctor-patient-relationship as well as low benefit with high effort.

Quantitative Data:

62% of the MPs’ surveyed answered that they would like to use telemedical approaches. 81% of the participants supported doctor-doctor communication via telemedicine. Only 47% of the MPs’ surveyed supported doctor-patients communication via telemedicine. MPs’ state that there are barriers which prevent them from implementing telemedicine (89%). These are among others acquisition of technology, administrative expenses and poor remuneration.

53% of the patients surveyed stated that they had heard the term telemedicine before. 30% of the participants answered that they would like to try out telemedicine. 38% answered with “no” and 29% with “do not know”. Further results from the patient survey will be available in June 2020.

Conclusion:

The study results show high acceptance rates of telemedicine regarding doctor-doctor communication. Doctor-patient communication via telemedicine is less accepted. However, MPs’ are reporting obstacles preventing the implementation of telemedicine in rheumatology. In order to implement telemedicine in rheumatological care comprehensively, adequate conditions must be established in the German health care system.

References:

[1]Zink A, Braun J, Gromnica-Ihle E, Krause D, Lakomek HJ, Mau W, et al. Memorandum der Deutschen Gesellschaft für Rheumatologie zur Versorgungsqualität in der Rheumatologie – Update 2016. Zeitschrift für Rheumatologie. 2017;76(3):195-207.

[2]McDougall J, Ferruci E, Glover J, Fraenkel L (2017) Telerheumatologiy: A Systematic Review. Arthritis Care Res (Hoboken); 69(10):1546-1557.

[3]Piga M, Cangemi I, Mathieu A, Cauli A (2017) Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum 47(1):121-128.

Disclosure of Interests:

Felix Muehlensiepen Grant/research support from: Novartis, Wenke Marquardt Grant/research support from: Novartis, Johannes Knitza Grant/research support from: Research Grant: Novartis, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, EIT Health, EU-IMI, DFG, Universität Erlangen (EFI), Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Martin Welcker Grant/research support from: Abbvie, Novartis, UCB, Hexal, BMS, Lilly, Roche, Celgene, Sanofi, Consultant of: Abbvie, Actelion, Aescu, Amgen, Celgene, Hexal, Janssen, Medac, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: Abbvie, Aescu, Amgen, Biogen, Berlin Chemie, Celgene, GSK, Hexal, Mylan, Novartis, Pfizer, UCB