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COVID-19 has created new challenges and opportunities in the way that rheumatologists care for chronically ill patients, including the introduction and prevalence of telemedicine and digital health applications (DHAs).
Both patients and physicians alike have shown increased acceptance and usage of digital health applications (DHAs), which may point towards a permanent shift in treating and managing rheumatic and musculoskeletal diseases (RMDs), according to a study published in BMJ Journals.1
COVID-19 has created new challenges and opportunities in the way that rheumatologists care for chronically ill patients, including the introduction and prevalence of telemedicine and DHAs. As RMDs are complex conditions, patients are encouraged to schedule regular follow-up appointments for the purpose of monitoring and treating their disease, which includes tracking symptoms, bloodwork, measuring treatment response, and re-evaluating treatment if necessary.
“The use of digital tools offers both sides a variety of new opportunities, such as new ways of communication and knowledge exchange (ie, via social media), new possibilities for identifying diagnoses, personalized treatment and disease monitoring via digital tools (such as apps or wearables), as well as an efficient and simple exchange of electronic information for both clinical and scientific purposes,” stated investigators.
To further explore this, an online survey, which ran from September 9, 2020 through October 15, 2020, was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League Against Rheumatism. An expert panel designed the questionnaire during 2 online meetings, and the German League Against Rheumatism edited and approved the final draft. The survey focused on 3 areas of interest: current usage of DHAs, DHA preferences, and the most prevalent barriers and advantages. It was distributed via social media (Twitter, Instagram, and Facebook), QR code, and email. Investigators aimed to show correlations using regression analyses.
The responses of 299 patients and 129 rheumatologists were accounted for and analyzed. The mean age of patients was 49 years and the majority of participants was female (79.9%, n=239), whereas the genders of the rheumatologist cohort were balanced (48.5% female). Investigators found that most patients (74%) and rheumatologists (76%) believed that DHAs were useful tools for managing RMDs and were confident in their own usage of them (90% and 86%, respectively). In fact, 74.6% of patients reported using DHAs several times a day, 14% used them once a day, 3.7% used them once a week, and only 4% never used the apps at all.
The survey discovered that informative DHAs (63.2%, n=189) and symptom checkers (40.5%, n=121) were the applications most often used by patients. When asked about self-collected blood samples at home, 51.2% of patients (n=153) were opposed to the idea and 43.5% (n=128) stated that they would consider it.
Patients were interested in virtual consultations for follow-up appointments (40.6%, n=71) as well as emergency appointments (38.3%, n=67). Most patients (81.3%, n=243) and rheumatologists (85.3%, n=110) agreed that on-site appointments could be skipped if disease state is stable and the patient was willing to confirm by using a DHA.
Despite the overall positive trends, the majority of patients believed that the effect of patient-physician relationships via telemedicine has both positive and negative aspects (42.1%), 26.8% of patients rated it positively, 10.7% rated it negatively, and 10.4% had no influence. The same was seen among rheumatologists, with 48.1% expressing the possibility of both positive and negative consequences, 32.6% viewed it positively, and only 8.5% had a negative attitude.
Advantages of DHAs included the flexibility to use them in any location at any time of day, cost-saving aspects, more detailed documentation, opportunities to provide information, diagnostics, and therapy, and patients’ ability to prepare for discussions.
The biggest disadvantage was the lack of information regarding DHAs, as noted by 175 patients (58.5%) and 54 rheumatologists (41.9%). Additional barriers included lack of usability (42.1%, n=126), not enough evidence for the benefits of DHAs (23.3%, n=30), poor quality, data protection concerns, and lack of internet or smartphones.
The online survey boasted a potentially diverse sample of RMD patients and physicians; however, results may be somewhat biased towards users who are already digitally adept. Additionally, another detriment was a lack of internet access or a smartphone. The elderly or those with a poorer socioeconomic background may not have the skills or equipment to take advantage of DHAs, which could create a digital divide for these patient populations.
Investigators also considered the impact of telemedicine on the patient-doctor relationship, as the “emotional and physical gap” between the patient and their physician may hinder the establishment of an emotional relationship. Further, as there is an inherent lack of physical contact, examinations may be more difficult in a virtual setting. However, the study showed that most patients and physicians report positive trends in digitization of appointments, with only 0.7% of patients and 8.5% of physicians expressing completely negative concerns.
“To our knowledge, this is the first conjoint analysis assessing both patient and physician perspectives on digitalization in rheumatology during the COVID-19 pandemic,” concluded investigators. “We believe that our results may guide future recommendations, research and, most importantly, clinical practice. Our results highlight the current need for clinical studies and, in preparation for these studies, the implementation of guidelines for the use of telemedicine in rheumatology.”
Kernder A, Morf H, Klemm P, et al. Digital rheumatology in the era of COVID-19: results of a national patient and physician survey. RMD Open. 2021;7(1):e001548. doi:10.1136/rmdopen-2020-001548