Patient-initiated follow-up, telemedicine lead to more efficient spondyloarthritis care
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Key takeaways:
- Patient-initiated follow-up with asynchronous telemedicine led to fewer rheumatology visits and saved costs.
- The program led to no loss of quality-adjusted life-years vs. usual care.
Individuals with spondyloarthritis can reduce their number of rheumatology visits through patient-initiated follow-up with asynchronous telehealth, without sacrificing outcomes, according to data published in The Lancet Rheumatology.
“Rheumatology is at a critical juncture due to a growing disparity between workforce shortages and an increasing demand for health services, which may ultimately threaten the quality of care,” Kasper Hermans, MD, of the division of rheumatology at Maastricht University Medical Center, in the Netherlands, told Healio.
“Importantly, the TeleSpA study not only generates evidence to support the fast-paced adoption of similar remote care interventions currently observed in rheumatology practice, but also provides an evidence-based, pragmatic intervention that can be translated into real-life care, to safeguard accessibility and flexibility for both patients with stable SpA and health care providers,” he added.
To examine the cost and clinical effectiveness of patient-initiated follow-up via asynchronous telemedicine in spondyloarthritis management, Hermans and colleagues conducted the TeleSpA study. In this multicenter, pragmatic, open-label randomized controlled analysis, the researchers tested a system where patients could request follow-ups on demand rather than visit at set intervals.
Adult patients with SpA were randomly assigned to either receive usual care — defined as a visit at baseline and 1 year, with follow-ups at the rheumatologist’s discretion in between — or use a patient-initiated follow-up system. In the latter group, patients submitted a remote monitoring questionnaire to rheumatologists at 6 months. Patients could request a physical or telephone appointment to replace the questionnaire.
The primary outcome was the number of rheumatology visits in 1 year. The researchers also evaluated the cost effectiveness of the patient-initiated follow-up program through a trial-based, 1-year health-economic analysis.
The trial involved 200 patients (mean age, 55 years; 40% women) between Dec. 2, 2020, and June 20, 2022. After 1 year, the average number of rheumatology visits was lower in the patient-initiated follow-up group (1.9; standard deviation: 1.5), compared with the usual care group (2.6; standard deviation: 1.3), for a mean difference of –0.7 (95% CI, –1 to –0.3), according to the researchers.
The patient-initiated follow-up program was not found to be cost-effective in unadjusted analyses, but “dominated” usual care after adjustment, Hermans and colleagues wrote. Specifically, the adjusted analysis found lower costs (incremental costs: –180; 95% CI, –921 to 560) with no loss in quality-adjusted life-years (0.004; 95% CI, –0.022 to 0.03) from patient-initiated follow-up with asynchronous telemedicine.
“Considering the anticipated rise in health care demand together with declining resources, time for synchronous care will become increasingly scarce,” Hermans and colleagues wrote. “This study shows that [patient-initiated follow-up] supported by telemedicine can reduce the need for consultations in patients with stable disease, which could lead to increased accessibility for other patients.
“In an era of declining health care personnel and rising health care costs, [patient-initiated follow-up] and asynchronous telemedicine could be a valuable approach for follow-up of patients with stable spondyloarthritis,” they added.
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