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Introduction: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation, causing pain and stiffness in the joints. SARS-CoV-2 increases the clinical vulnerability of the population with RA and has led to the implementation and/or development of telemedicine. Objective: To describe changes in level of therapeutic adherence, quality of life and capacity for self-care agency, during the follow-up period of a group of patients linked to a non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methodology: Descriptive cohort study (July to October 2020). Description of the level of therapeutic adherence (Morisky Green Test), quality of life (EuroQOL-5-Dimensions-3-Level-version) and self-care capacity (ASA-R Scale) in the context of a telehealth model. A univariate and bivariate analysis was performed (Stata Software, Considered p-value <.05) Results: Of 71 patients treated under the telehealth model, 85.9% were women, the age range was between 33 and 86 years with a median of 63. The most prevalent comorbidity was arterial hypertension (35.2%). Quality of life did not change during follow-up nor did adherence to treatment, apart from in one item [the patients did not stop taking the medication when they were well (P=.029)]. In self-care capacity, there were significant improvements in five dimensions (P<.05), without significant differences in the global score. Conclusion: Patients with RA evaluated in the context of telehealth in a period of pandemic did not present significant changes in quality of life, adherence to treatment, or capacity for self-care, and remained close to baseline values when they attended a traditional face-to-face assessment.
ABSTRACT
Objectives: Rheumatoid arthritis (RA) is a disease highly vulnerable to COVID-19, a factor that caused an impact on everyday practice and the implementation of tele care assistance. Our goal was to understand the experiences of RA patients and health care professionals (HCP) in the implementation of a non-face-to-face multidisciplinary consultation model in the health emergency caused by COVID-19. Methods: Qualitative descriptive exploratory study. Semi-structured interviews (telephone or video-based depending on the participant preferences) were carried out that analyzed the experiences of RA patients and HCP who cared for them in a specialized center in Bogotá (Colombia). All interviews were audio-recorded, with prior informed consent of the participants, and were conducted by researchers trained in qualitative designs. Inclusion criteria: Adult RA patients evaluated in the tele consultation modality on at least two occasions, patients treated in the face-to-face consultation modality on at least two occasions and health professionals who have carried out at least 25 tele consultations, in the context of the health emergency due to COVID-19. It was analyzed following the Taylor-Bogdan proposal. Results: 36 interviews were conducted, 29 (80.5%) corresponded to RA patients (69% were attended by tele consultation and 31%, through face-toface consultation);and 7 (19.4%) corresponded to HCP. Characteristics of participants are shown in table 1 and 2. Four categories emerged configuring the experience of the subjects (patients and professionals) in a scenario of high vulnerability and uncertainty derived from the COVID-19 pandemic: Factors present in communication, information and communications technology (ICT) management, family support and interaction, and adherence to treatment. In patients, mental health, pain, functional dependence, and quality of life, were the most affected dimensions. Resilience mechanisms such as adaptation and self-care measures emerged to minimize risks from pandemic. Conclusion: Clinical and social conditioning factors were identified, which may determine the relevance of tele consultation. The implementation of tele consultation should be accompanied by the training of HCP, digital literacy and investment in technological infrastructure to overcome barrier access. It is important to promote assertive communication processes in the professional-patient relationship mediated by ICT.
ABSTRACT
Objectives: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic joint inflammation, causing intense pain and stiffness. SARS-CoV-2, as the main pathogen of the current pandemic emergency, increases the clinical vulnerability of the population with RA and led to the implementation of tele consultation. Our objective was to analyze the changes in the level of therapeutic adherence, quality of life and the capacity for self-care agency during the follow-up period of the group of patients linked to the non-face-to-face multidisciplinary consultation model during the SARS-CoV-2 pandemic. Methods: A longitudinal analytical cohort observational study in adult RA patients evaluated in a specialized center under a tele care model in Bogotá, Colombia was carried out. Three instruments: EuroQoL-5 Dimensions (EQ 5-D-3 L), Morisky Green Test and The Appraisal of Self-care Agency Scale (ASA-R), to measure quality of life, adherence to treatment and self-care agency respectively, were administered. Data was collected by telephone interview between a three-month period (baseline and third month measurement). Ethical approval was granted. A quantitative comparison between follow up and baselines measurements was done (p-value<0.05 was considered significant) Results: Of 71 patients included and evaluated in tele consultation modality, 85.9% were women, with an age range of 90 years (Table). The most prevalent comorbidities were musculoskeletal (14.1%). Regarding the variables analyzed, the quality of life, pain/discomfort, anxiety/depression, and mobility were the variables most affected. In the 3-month follow-up period, no differences in EQ 5-D-3 L score and dimensions were found (p = 0.659). During follow-up, in adherence to treatment, patients did not stop taking medication when they were well (p = 0.029);As well, in the self-care agency, they took measures to guarantee their safety and that of their family (p = 0.000), they changed life habits to improve their health (p = 0.004) and they looked for betterways to take care of themselves (p = 0.026). Conclusion: The teleconsultation implemented in patients with RA during the SARS-CoV-2 pandemic had a high degree of acceptability, found significant changes in the variables of adherence to treatment and self-care agency and without significant changes in quality of life. This study provides new findings in the evaluation of the tele-assisted monitoring model in the context of a health emergency due to COVID-19 in Latin-American RA patients.
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Objectives: The COVID-19 pandemic has impacted everyday practice pattern of health care in rheumatoid arthritis (RA) patients. The objective was to evaluate the implementation of a tele-consultation program in an adult population with RA Methods: Analytical observational study longitudinal cohort (Clinical trials NCT04768413) that evaluated the effectiveness of a tele consultation model compared with a face-to-face consultation model in adult RA patients. Patients were followed 12 weeks (Jul-Oct 2020) at an RA center of excellence in Colombia. Simple random sampling was done. Two groups were included: Group A, patients who were cared for by tele-consultation care and Group B, thosewho wished to continue with the usual face-to-face consultation. Data regarding activity of disease (Week 0,6,12) [Patient Activity Scale (PAS) in both groups and DAS28 in group B], and Quality of life [EQ-5D-3L], disability [Health Assessment Questionnaire (HAQ)], therapeutic adherence [Morisky-Green Adherence Scale (MGLS)] and self-care capacity [Appraisal of Self-care Agency Scale -Revised (ASA-R)] were evaluated (weeks 0-12). Outcomes regarding COVID-19 were evaluated. Bivariate analysis was done (StataV-13;P-value<0.05). Results: 218 adults were included: (109/Group A-109/Group B). The groups did not differ in general characteristics (Table). Group A: (n = 71), no statistically significant differences were observed in the median scores of VAS global, VAS pain, PAS, HAQ, EQ-5D and ASA-R while increase in adherence was demonstrated (MGLS, without statistical significance). Group B: (n = 18), a significant increase in adherence (MGLS, p = 0,019) and in self-care (ASA-R, p = 0,0077) were found, no other differences were found (including DAS-28). A third group was constituted by patients that transited between the two models (figure). An increase in ASA-R was demonstrated in this group presential >remote>presential (p = 0,0001);the same result was documented in the group presential>remote>presential, with an increase in adherence (p = 0,033). 7 patients developed COVID-19 (one patient hospitalized/group A and one patient died/mixed model) Conclusion: In the tele consultation model patients remained adherent to their RA treatment, without major differences compared to the face-to-face model. It is important to know these results due to the impact they have, given the changes that will follow in the care of RA patients due the current pandemic. Studies with a longer follow-up period are required to corroborate these results.
ABSTRACT
Background: The Covid-19 pandemic has generated restrictions in the mobility of people, affecting the face-to-face care of patients with chronic diseases, including autoimmune. The health emergency has created the need to establish follow-up alternatives, giving rise to telemedicine. Objectives: To evaluate the level of attendance to teleconsultation and the faceto-face usual care in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) who underwent to a developed innovative telemedicine program after the declaration of quarantine due to the Covid-19 pandemic. Methods: The present cross-sectional descriptive study reports retrospective data collected from patients with RA and SLE from March to June, 2020;. Since the beginning of March 2020 when Covid-19 was declared in Colombia as a health emergency establishing specific standards for outpatient care, our center has made the necessary legal and technical adjustments to develop an innovative telemedicine service to prevent the epidemiological risk. To all contacted patients were offered the option of teleconsultation or face-to-face consultation;a standardized protocol was set with clinimetry measures evaluated in both groups. Continuous variables were described using mean and standard deviation, and categorical variables were described using numbers and percentages. We performed chi-square tests of independence to determine differences between teleconsulting and conventional face-to-face consultation. Results: A total of 5745 RA patients were followed-up, 5292 (92.1%) by teleconsulting and 453 (7.9%) by conventional face-to-face consultation;among the group of SLE patients, a total of 646 were assessed, of which there were 386 (60%) by teleconsultation and 260 (40%) by face-to-face consultation;this highlights an important difference in the level of acceptance of the teleconsultation between patients with RA and SLE, being much lower in patients with SLE (p value< 0.0001). Regarding gender differences, in men, there were 33 (12.7%) SLE and 89 (19.6%) RA face-to-face consultations, while in women there were 227 (87.3%) SLE and 364 (80.4%) RA in a face-to-face consultation. Regarding patients who were attended through telemedicine, 45 (11.7%) SLE and 966 (18.3%) RA were men, while 341 (88.3%) SLE and 4326 (81.7%) RA were women;that means, in the RA cohort, a greater number of men prefer the faceto-face consultation than in the SLE cohort (p value< 0.0185). 10 RA patients were diagnosed with the Covid-19 in teleconsultation;in all cases, close contact with infected relatives was verified as the probable cause. Conclusion: Telemedicine may provide a viable option for the follow-up of patients with rheumatological diseases even beyond the pandemic. But unexpectedly, data showed an important difference in the acceptance of teleconsultation between patients with RA and SLE, being much higher in older and/or male patients with RA compared to patients with SLE;however, further studies are needed to support this conclusion.