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“This dramatic change in healthcare delivery led to significant challenges amongst healthcare management teams, healthcare professionals as well as patients, especially during the early phases of implementation," investigators stated.
While patient-reported views on virtual consultations during the COVID-19 pandemic varied, patients with psoriatic arthritis (PsA) who had an established relationships with their rheumatologist and those with well-controlled symptoms were more likely to report favorable views on remote appointments, according to a study published in BMC Rheumatology.1
“Telemedicine was rapidly adopted as a method of continuing rheumatology services across the UK, particularly as many patients were advised to shield at home during this period,’ investigators explained. “This dramatic change in healthcare delivery led to significant challenges amongst healthcare management teams, healthcare professionals as well as patients, especially during the early phases of implementation.”
Investigators involved in the British Psoriatic Arthritis Consortium (BritPACT) committee developed an 18-question e-survey, distributed in January 2021, to analyze the unmet needs and patient-reported impact on clinical care during the COVID-19 pandemic in this patient population. Details about treatment, the type and effectiveness of telemedicine appointments, and demographics were included within the survey. Patients were also able to respond to open-ended questions. Investigators then grouped, synthesized, and summarized patient-reported responses into categories to account for any overlap in responses.
A total of 128 patients responded to the survey, of which 109 rated the effectiveness of their telemedicine experience. Of those patients, 18% believed their virtual consultations were very or extremely effective, 49% reported that it was somewhat or equally as effective, and 8% believed they were not effective at all.
Most patients (62%) reported that remote consultations would not impact their condition and their ability to attain remission and 51 patients (48%) believed telemedicine consultations would continue to be beneficial after the pandemic. However, 55% thought telemedicine hindered holistic care and 54% stated that remote consultations would not allow for good rapport and communication within their clinical team.
Issues reported included a lack of visual cues and physical examinations as well as effects on communication and rapport. The waiting times were better (38%) or about the same (56%) for virtual appointments, compared with only 6% rating them as worse for in-person visits. Non-verbal cues, body language, and the inability to see and touch the joints and skin may also lessen the rheumatologist’s ability to assess coping, mood, and wellbeing.
While many patients understood the benefits, including travel time and costs, those with well-controlled symptoms and those with a previously established relationship with their clinician were generally more satisfied with their monitoring appointments. Overall, there was some concern that a patient’s health may deteriorate if they were not able to be seen in a clinical environment for a prolonged period. Additionally, the importance of being able to switch between telemedicine and in-person clinic appointments was noted within patients PsA.
Limitations of the study included the lack of information on disease duration, which may cause discrepancy in patient-reported satisfaction of telehealth visits in those with newly diagnosed PsA and those with well-established treatment. Additionally, the results may not be truly representative of this patient population as the electronic nature of the survey, distributed on social media to those who were already involved in PsA networks and organizations, inherently excluded those with no access to technology.
“Patient perspectives on service design and changes are increasingly important. More engagement of patient partners should be sought after by clinical departments in order to improve our understanding as this, in turn, may help improve the patient satisfaction aspect of clinical care outcomes,” investigators concluded.
Jethwa H, Brooke M, Parkinson A, Dures E, Gullick NJ. Patients' perspectives of telemedicine appointments for psoriatic arthritis during the COVID-19 pandemic: results of a patient-driven pilot survey. BMC Rheumatol. 2022;6(1):13. Published 2022 Feb 22. doi:10.1186/s41927-021-00242-y