TELERHEUMATOLOGY with PRIMARY CARE CENTERS: FEEDBACK from AN EXPERIMENTAL TELEMEDICINE PROJECT in BURGUNDY (2019-2021)

ABSTRACT

Background: Telemedicine could be an innovative and sustainable response for rheumatologic advice in areas with low medical density. Improving coordination of investigations, access to allied health members and dedicated telehealth platform may improve the management of many rheumatologic patients. Methods: This French TeleRheumatology project with multidisciplinary primary care centres was set up in 2019, specifcally targeting the Burgundy region in Eastern France and was fnanced by the Regional Health Agency. Four rheuma-tologists from the Dijon University Hospital took turns to respond to the various requests for telemedicine (teleconsultation, teleexpertises) on a dedicated digital platform integrating a medical imaging viewer. In addition to the activity (number and type of procedures performed) and the distances avoided for the patient for rheumatology consultation, feasibility of this colaborative digital project was assessed on the basis of a participant satisfaction questionnaire (rheumatolo-gists, general practitioners and patients). Results: From October 2019 to january 2022, this TeleRheumatology project allowed the progressive integration of 23 primary care centres despite the concomitant COVID-19 crisis which slowed down the deployment. 212 procedures were performed (96% teleexpertises) 76% for mechanical disorders (spine 31%, osteoporosis 19%, osteoarthritis 15%), 18% for infammatory rheumatism, 53% advice for diagnosis, 41% for management and/or therapy, 89% with imaging (X-Rays, CT-Scan, MRI) to be reviewed. The average response time was 16 hours and the average number of round-trip kilometers avoided was 216. Only 15% of the rheumatologic advices led to a face-to-face consultation or hospital-ization at the University Rheumatology Department and 6% to other specialists. 97% of the patients would like to use this Telerheumatology program again (Satisfaction score 9.1/10). 100% of the expert rheumatologists (satisfaction score 9.25/10) and the general practitioners (satisfaction score 9.0/10) wanted to continue this digital health partnership in their daily practice. Conclusion: Despite the inherent limitations of telemedicine (absence of clinical examination, technical barriers of interoperability, etc.), this french innovative TeleRheumatology project with primary care centres has shown encouraging results in terms of acceptability and satisfaction thanks to the coordination of the Regional Health agency and physicians' motivations. Telerexpertise seems to be the preferred modality given its better practical feasibility. Approval and acceptance are increasing in the Rheumatology community because telemedicine appears to be an effective tool for improving health care access as demonstrated by its rapid expansion, especially during the COVID-19 pandemic.