Patients, clinicians express 'strong' preference for in-person visits over telemedicine
Click Here to Manage Email Alerts
Rheumatology patients and clinicians alike express a “strong” preference for in-person visits rather than telemedicine, citing concerns over reduced assessment accuracy and increased inequality for vulnerable groups, according to data from the U.K.
However, despite their misgivings about the technology, more than 60% of the study respondents allowed that telemedicine was more convenient than face-to-face visits.
“This study was of great importance as it is the first study of telemedicine in rheumatology to combine and compare acceptability of multiple different aspects of telemedicine among a variety of clinician roles and inflammatory rheumatology disease groups,” Melanie Sloan, BSc (Hons), PGDip, of the University of Cambridge, in the United Kingdom, told Healio Rheumatology. “The move towards telemedicine has been very rapid through pandemic-induced necessity, but with insufficient planning and consultation and with systems that cannot yet cope efficiently and safely with this transition.”
To examine the experiences and views regarding telemedicine among rheumatology patients and clinicians, Sloan and colleagues conducted a sequential mixed methodology combined analysis of surveys and interviews. For the survey portion, researchers released a pre-tested questionnaire online in April via multiple rheumatic disease support groups. A similar online survey for rheumatology clinicians was released through various professional networks, including the British Society for Rheumatology, in May and June.
For the interview portion, researchers purposely selected survey participants to ensure a range of characteristics and views. Interviews were semi-structured and continued until the researchers reached thematic saturation. Participating patients were adults with a diagnosis of an autoimmune inflammatory rheumatological disease on their clinic letters, who attended at least one telemedicine appointment. Clinicians were required to be based in the United Kingdom and involved in the care of rheumatology patients, and included consultants, registrars, specialist nurses and general practitioners.
A total of 1,340 patients and 111 clinicians responded to the surveys, while 31 patients and 29 clinicians were interviewed. Among the patients, 96% were from the United Kingdom, with the most common diseases being inflammatory arthritis and lupus — 32% for each. The researchers used t-tests to examine between and within group differences in views regarding telemedicine.
According to the researchers, who published their findings in Rheumatology, both patients and clinicians rated telemedicine as worse than in-person in almost all categories, despite more than 60% finding the former more convenient. As much as 93% of clinicians and 86% of patients rated telemedicine as worse than in-person appointments for assessment accuracy. Building trusting medical relationships was also a great concern with telemedicine, Sloan and colleagues wrote.
Additionally, participants reported they believed telemedicine was associated with increased misdiagnoses, inequalities and barriers to care assess. Respondents also reported highly disparate telemedicine delivery and responsiveness from primary and secondary care. Although rheumatology clinicians stressed the importance of responding quickly to flares, just 55% of patients reported they were confident that their rheumatology providers would respond within 48 hours.
“The study found a high preference for face-to-face appointments among clinicians and patients, although greater convenience was a positive,” Sloan said. “The authors pointed out that some negative views may also be due to pandemic constraints and backlogs rather than telemedicine itself. The potential of integrated remote systems where patients can rapidly access support and their test results has yet to be realized but could be very positive in terms of self-management and empowerment.
“The importance of further consultation with clinicians and patients was highlighted, as there were concerns that telemedicine may be over-used by government and hospital management to save time and costs yet may not always be in each patient's best interests,” she added. “Assessing each patient's individual needs and preferences was felt to be of key importance. Training, choice and ensuring rapid access to medical support were considered essential.”
Perspective
Back to Top
The COVID-19 pandemic has certainly sparked a myriad of debates in the medical community. One of particular interest for rheumatology professionals is the role of telemedicine within a specialty that relies heavily on hands on assessments and treatments. Two years in, we have all had experience with telemedicine, whether by phone or video platforms, with new or established patients and with stable or flaring patients. How well has telemedicine worked for our patients, providers and even clinic staff? Sloan and colleagues set out to answer these questions.
Within the data collected, three points clearly stood out for me. First, patients and clinicians felt telemedicine was more convenient, but also less personal, highlighting the importance of observational skills and nonverbal cues picked up during face-to-face visits. Both groups expressed great concerns for delayed diagnosis or misdiagnosis and treatments for initial consultations, suggesting that not every patient is a candidate for telemedicine.
Finally, everyone felt technology was an issue emphasizing the need to fine-tune telemedicine platforms, provide better training for clinicians as well as patients and develop alternatives for our non-technologically-savvy patients, such as our elderly or hearing/vision-impaired patients.
Although this study was conducted in the UK, the results have universal implications. Telemedicine is here to stay; the challenge before us is to develop strategies that will efficiently and effectively utilize telemedicine to the benefit of our rheumatology patients.
Collapse
Read more about
Click Here to Manage Email Alerts