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Telehealth, which includes any form of health care services that are delivered via telephone, video chat, app, or any other means of connection aside from an in-person visit, has become popular — out of necessity — during the COVID-19 pandemic. But is a virtual visit as good as an in-person one?

For rheumatology patients, researchers are studying which kinds of visits lend themselves better to in-person vs. telehealth care.

In a new study, published in the journal Rheumatology, researchers evaluated rheumatology appointments conducted by doctors at Monash Health, the largest health service provider in Australia.  They compared 1,443 in-person rheumatology appointments that occurred between April and May 2019 to 1,597 telehealth appointments that took place between April and May 2020. Nearly all (97 percent) of the telehealth appointments were conducted via telephone audio only.

Fewer Diagnoses of New Patients

The researchers found that patients who sought a rheumatology appointment without a pre-existing diagnosis during the telehealth period were significantly less likely to get diagnosed compared to those who saw a provider in person in 2019. This is not a total surprise, as doctors can’t complete hands-on physical exams or conduct blood or imaging tests over the phone. Additionally, since almost all the telehealth visits in this study were limited to audio-only, doctors weren’t able to look at the patients, which would also help with making a diagnosis.

Fewer Medication Changes

New patients weren’t the only ones whose care was negatively impacted by telehealth. For existing patients, the biggest downside was that they were told to schedule follow-up appointments sooner than usual, likely because doctors needed to see and touch them to accurately monitor their progress. That might mean patients have to carve out additional time to see their provider or pay an additional copay.

They were also less likely to be told to change their current immunosuppressive medication compared to those who had been seen in person. Although the researchers don’t know why this happened, it’s possible that doctors were reluctant to make too many medication changes during the pandemic, especially if they couldn’t thoroughly examine a patient before doing so. This could be problematic for people with high disease activity who are not reaching their treatment targets and would benefit from altering their medication treatment.

“While the effects of telerheumatology cannot be differentiated from changes in practice related to the pandemic, these findings suggest telephone-based telerheumatology may have a negative impact on the timeliness of management of rheumatology patients,” the authors said.

Better Appointment Attendance

That said, there were some benefits to telehealth rheumatology appointments. For example, patients were more likely to keep their scheduled appointments, with only 6.5 percent of telehealth patients cancelling compared to 11 percent of in-person patients.

Additionally, the number of patients who ended up in the hospital because of complications of their rheumatic condition held study regardless of whether they had a telehealth or in-person visit. This suggests that the telehealth appointments worked well enough for keeping most patients stable.

Should I Use Telerheumatology or Have an In-Person Visit?

The hope is that, as more people receive the COVID-19 vaccine, pre-pandemic activities will resume, including in-person doctor appointments. But telehealth has important benefits for patients — especially convenience — and a long-term role in our health care system.

It may be the case that telehealth visits become more like a triage tool to help patients and providers determine whether and what kind of in-person care is needed.

For patients who have an existing diagnosis and are doing fairly well, telehealth rheumatology appointments are a viable option. They can save patients time, money, and help reduce issues like fatigue and brain fog that come from trekking to doctor visits, particularly when long commutes are needed to get medical care. For other situations, particularly when patients are experiencing new or worsening symptoms or require lab testing or imaging, in-person visits are likely necessary.

Keep in mind that the quality of the telehealth visit also matters. A visit with good-quality video where your doctor is able to see and evaluate your joints and where you have a quiet space to focus and have a one-on-one conversation may be a lot different than a telephone-only visit, or a visit where you’re distracted by your home environment (say, with kids underfoot).

If you’re experiencing symptoms or have questions about your condition, the most important thing is that you see a health care provider — either virtually or in person — rather than put off getting care. If you are not able to make an in-person appointment or don’t feel comfortable attending one, schedule a telehealth appointment with a rheumatologist and push for a video component.

Want Better Virtual Care with Your Rheumatologist?

For personalized advice on getting the most out of your rheumatology telehealth visits, check out eRheum.org.

Wendy Z, et al. The impact of telerheumatology and COVID-19 on outcomes in a tertiary rheumatology service: a retrospective audit. Rheumatology. March 1, 2021. doi: https://doi.org/10.1093/rheumatology/keab201.

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