EVALUATION of the USE of VIDEO CONSULTATION in GERMAN RHEUMATOLOGY CARE before and during the COVID-19 PANDEMIC WAVES

ABSTRACT

Background: During the COVID-19 pandemic telemedicine tools rapidly and widely gained acceptance as indispensable management tools for the continuum of clinical care in rheumatic diseases. They have been adopted in position papers and guidelines for the management of rheumatic diseases in adult patients. Objectives: Evaluation of the use of video consultation as one form of tele-medicine before and during the COVID-19 pandemic and associated lockdowns among Rheumatology physicians in Germany. The survey results are expected to support the optimization and implementation of video consultation (VC) into routine clinical practice in rheumatology, providing long-term benefts for both parties, patients and their treating rheumatologists. Methods: Cross-sectional nationwide online survey among German rheumatolo-gists and rheumatologists in training. The survey was promoted by newsletters sent by means of mail and Twitter posts to members of the German Society for Rheumatology (n=1,650) and German Professional Society for Rheumatology (n=527). Results: Reported data refer to 205 participants. The majority of respondents was male (59%), older than 40 years (90%) and specialized in internal medicine/rheumatology (85%). They were divided into two groups 'digital users' (38%) and 'digital non-users' (62%). Users employing telemedicine (TM) but never VC were defned as 'TM-users' (10%). Those using TM and VC were classifed as 'VC-users' (27%). 'Non-users' negated the use of VC and TM respectively. Knowledge on telemedicine was self-rated as 4 (median on a Likert Scale 1 (very high) to 6 (very low)) with a signifcant difference between user (VC-user 2.7±1.2, TM-user 3.2±1.1) and non-user (4.4±1.3). The Figure 1 shows a signifcant increase in the use of VC during the lockdown periods. Even between the lockdown phases, VC use was higher than in the pre-pandemic phase. Reasons for VC non-use in TM-user and non-user were administrative/technical efforts (21%), lack of technical equipment (15%), time constraints (12%), time required for individual VC sessions (12%), inadequate reimbursement (11%), lack of demand from patients (11%), data security concerns (9%), poor internet connection (8%), and lack of Scientific evaluation/evidence (5%). Based on the experience gained, physicians considered the following clinical situations to be particularly suitable for VC follow-up visits (VC-user 79%, TM-user 62%, non-user 47%), emergency consultations (VC-user 20%, TM-user 33%, non-user 20%), and patients presenting for the frst time (VC-user 11%, TM-user 19%, non-user 8%). Conclusion: Despite the fact that the current pandemic situation, with social distancing and several lockdowns, provides an ideal environment for the implementation of new remote care forms such as VC, their use and acceptance remained below expectations. Given the reported decline in physician face-to-face consultations during the pandemic, these fndings are even more concerning. The identi-fed reasons for non-utilization should be addressed by policy makers, payers and medical societies to provide better foundations for future innovative care models.