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Using Telemedicine to Improve Rheumatoid Arthritis Care for Patients in Alaska

Using Telemedicine to Improve Rheumatoid Arthritis Care for Patients in Alaska

In this study of Alaska Native people with rheumatoid arthritis (RA), there was no difference in RA disease activity over 1 year, and no difference in quality of care for patients who receive rheumatology care through telemedicine versus patients receiving only in-person rheumatology care.

Fewer follow up visits may mean poor outcomes for patients

RA, a chronic autoimmune disease requiring frequent visits with a rheumatologist, disproportionately affects American Indian/Alaskan Native (AI/AN) populations. Access to rheumatologists can be challenging for these and other rural, minority populations. To improve patient access, telemedicine has been used for clinical care by rheumatologists at the Alaska Native Tribal Health Consortium since 2015. However, its impact on patient outcomes and quality of care had not been systematically evaluated.

To address this gap in telemedicine research, Dr. Elizabeth Ferucci and her team at the Alaska Native Tribal Health Consortium designed an observational study to evaluate disease activity and quality of care. Using a PRO measure, Routine Assessment of Patient Impact Data 3 RAPID-3, Dr. Ferucci examined patient-reported disease activity in patients having at least one telemedicine visit compared to patients having no telemedicine visits during the 12-month study period. The team also examined process measures of quality of care, including number of rheumatology visits during the year, proportion of visits where disease activity was measured, and proportion of visits with moderate or high disease activity in which a change in medications was prescribed. Dr. Ferucci and her team found patient outcomes and quality of care were similar to in-person and telemedicine visits, indicating that telemedicine is an acceptable method of followup.

As disparity in the health of rural versus urban populations becomes larger, the ability to see rural patients more often may improve long-term disease outcomes and help to close this disparity gap.”
– Dr. Ferucci

Perceptions and potential benefits of telemedicine

While most patients preferred to be seen in person, patients using telemedicine commonly reported that the care they received was as good as the care received during an in-person visit, suggesting that telemedicine is a viable option where access to care is an issue. More frequent provider followup, decreased costs of care, and more time during appointments for education and questions were all reported potential benefits of telemedicine. Dr. Ferucci’s future research will look at telemedicine outcomes in a larger set of chronic diseases over a longer period of time.