Evaluation of the Impact of Telemedicine on Management of Rheumatoid Arthritis (Alaska)

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Evaluation of the Impact of Telemedicine on Management of Rheumatoid Arthritis - Final Report

Citation:
Ferucci E. Evaluation of the Impact of Telemedicine on Management of Rheumatoid Arthritis - Final Report. (Prepared by the Alaska Native Tribal Health Consortium under Grant No. R21 HS024540). Rockville, MD: Agency for Healthcare Research and Quality, 2019. (PDF, 207.02 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. (Persons using assistive technology may not be able to fully access information in this report. For assistance, please contact Corey Mackison).
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Using Telemedicine to Improve Rheumatoid Arthritis Care for Patients in Alaska

COMPLETED RESEARCH - KEY FINDINGS AND IMPACT

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.

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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.

Project Details - Ended

Summary:

Rheumatoid Arthritis (RA), a chronic autoimmune disease predominantly affecting joints, can lead to high rates of disability and increased mortality. Guidelines for the treatment of RA require frequent visits to a rheumatologist. American Indian and Alaska Native (AI/AN) populations have a high burden of RA. In the United States, there is a shortage of rheumatologists that disproportionately affects minority and rural populations, including AI/AN populations. Improving access to rheumatologists for those with RA is expected to improve the quality of care for these patients.

The Alaska Tribal Health System has been a leader in telemedicine innovations. The system began with a robust store-and-forward mode of telehealth, but now, as broadband capability has improved, video teleconference (VTC) capability in multiple Alaska clinics has grown exponentially. The increase in availability of this technology is improving access to care, including rheumatologists, for AI/AN patients. This research evaluated the impact of telemedicine rheumatology via VTC followup on outcome and process measures of quality of care for patients with RA within the Alaska Tribal Health System.

The specific aims of the research were as follows:

  • Determine the impact of telemedicine on disease activity, a patient-centered outcome measure of quality of care for RA. 
  • Investigate the impact of telemedicine on process measures of quality of care for RA. 

Patients with RA seen by a rheumatologist with or without telemedicine VTC followup were enrolled in an observational study. Participants completed a patient-reported disease activity questionnaire, a telemedicine survey, agreed to medical record reviews at baseline and 12 months, and agreed to followup contact at 6 and 12 months. At baseline, factors associated with telemedicine VTC use included a higher number of rheumatologist visits, an increased amount of patient-reported disease symptoms, and more positive perceptions of telemedicine. At 12 months, there were no changes in disease activity or differences in process measures of quality care between the telemedicine VTC group and the in-person group. These findings suggest that telemedicine is not inferior to in-person care and may be an effective tool in managing RA. Researchers suggest future studies are needed to address the costs of telemedicine, and longer-term studies are needed to document the effectiveness of telemedicine in quality of care for RA and disease outcomes.