More than half of VA rheumatologists remain skeptical of telemedicine for new patients
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Despite their increasing comfort with video and telemedicine visits during the COVID-19 pandemic, most rheumatologists at the U.S. Department of Veterans Affairs remain skeptical of the technology’s use for new patients, according to data.
“A survey of VA rheumatology providers early in the pandemic April-May 2020 found that most providers were comfortable providing virtual care to established stable patients with autoimmune and inflammatory rheumatic diseases (AIIRD) and a significantly smaller proportion to new patients or those with active disease,” Jasvinder A. Singh, MBBS, MPH, of the Birmingham VA Medical Center and the University of Alabama at Birmingham, and colleagues wrote.
“In June/July 2020 many VA health care centers reopened their facilities to in-person visits but at limited capacity,” they added. “It was thus timely to repeat the national VA rheumatology provider survey to evaluate provider resilience and changes in providers’ view of telemedicine and their comfort with it in managing patients with AIIRD.”
To analyze the experience and practices of rheumatologists at VA facilities, as well as their views on outpatient management, and assess provider resilience with various modes of outpatient care, Singh and colleagues performed a follow-up cross-sectional survey among members of the VA Rheumatology Consortium.
Conducted via email from November 2020 to January 2021, the updated survey asked providers their opinions on the best health care delivery modes for rheumatology, which diseases are appropriate for telephone or video visits, and their own use and comfort with remote-visit technologies. Also included were new questions on laboratory monitoring for high-risk medication toxicity.
Meanwhile, the researchers measured provider resilience — or the ability to cope with stress — using a validated two-item Connor-Davidson Resilience Scale (CD-RISC2), scored from zero to eight, with higher scores corresponding to higher resilience. According to the researchers, the general population mean score ranges from 5.9 to 6.9, while the mean among physicians is 6.5.
Among 143 eligible members of the VA Rheumatology Consortium across the United States, a total of 114 responded to the follow-up survey. Of these participants, 64 reported that they had responded to the original VA COVID-19 survey.
According to the researchers, who published their findings in The Journal of Rheumatology, fewer VA rheumatologists reported using telephone visits — 78% versus 91% (P = .009) — with more using clinical video telehealth (CVT) — 16% versus 7% (P = .04) — or in-person visits — 76% versus 59% (P = .007) — compared with the original survey. Most responders reported that they were somewhat or very comfortable with the quality of visits for established, but not new, patients for telephone, video-based VA video connect (VVC), and CVT.
The mean CD-RISC2 score was 6.8 (standard deviation = 1.11), “significantly higher” than the original survey score of 6.35 (SD = 1.26) (P = .004), the researchers wrote. After adjusting for age, sex and ethnicity, high physician resilience was associated with significantly higher ORs for comfort with technology (1.71; 95% CI, 0.67-4.4) and the quality of VVC visits (4.13; 95% CI, 1.49-11.44) for established patients. High resilience was similarly associated with higher ORs for new patients — 2.79 (95% CI, 1.11-7.05) and 2.69 (95% CI, 1.06-6.82), respectively.
“Despite greater than 6 months experience with telemedicine, providers continued to have reservations with its utilization for new patients and specific AIIRD subpopulations,” Singh and colleagues wrote.
“Greater technology education for patients and providers, and more ancillary staff support to providers, could improve the acceptance of telemedicine and its appropriate use,” they added. “The knowledge of barriers to the use of technology in providing optimal rheumatology care, and the association of provider resilience with comfort with telemedicine, can inform health care policymakers and allow delivery of optimal health care to patients with rheumatic diseases in one of the largest integrated healthcare systems in the U.S.”
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