THE USEFULNESS of TELEMEDICINE in RHEUMATOLOGY: POINTS of VIEW of PRACTITIONERS and PATIENTS

ABSTRACT

Background: The advent of COVID-19 has allowed a rapid expansion of tele-medicine (TM) and its implementation in various specialties. Despite this extensive use of TM, its role in rheumatology is conficting and much remains unknown about TM's acceptability and efficiency in rheumatology [1]. Objectives: Our study aimed to evaluate rheumatologists' and patients' willingness for TM and factors helping to adopt this alternative. Methods: We conducted a cross-sectional study including patients attending our rheumatology department as well as rheumatologists. Patients were contacted by phone and rheumatologists were invited to answer a questionnaire via Google Form. We evaluated their points of view and suitability for TM by inquiring about their experience with tele-rheumatology, information technology supports, personal barriers to telemedicine, and reasons for adopting this alternative. Moreover, additional questions probed the clinician's perception of the appropriate clinical context for TM application as well as the corresponding legislation. Results: Overall, 135 responses were collected including 60 rheumatolo-gists and 75 patients. The distribution of diagnosis was as follows rheumatoid arthritis (RA) (n=15), spondyloarthritis (SpA) (n=20), juvenile idiopathic arthritis (n=23), and osteoarthritis (n=17). Of the rheumatologists, 76.2 % were aged between 30 and 50 years old, 79.3% reported working at an academic center, and the majority were physician-level practitioners (71.2%), working for more than 5 years (61%). Afforded electronic devices were as follows laptop (87.9%), smartphone (70.7%), afforded headset microphone (24.1%), camera (29.3%) for doctors. Forty-six percent of the rheumatologists estimate that they have a good internet connexion, 62.7% had an appropriate place for teleconsultation. Nearly, 40.7% of the rheumatologists were familiar with the concept of TM but only 39% reported experience with TM. Willingness to accept this model of care for rheumatologists and patients was found in 78% and 37.3% respectively. According to the doctors, the benefts of TM encompassed tele-training (61.7%), remote medical monitoring (61.7%) especially during the COVID-19 (70.2%), benefts for patients (74.5%), reduced inequalities in access to healthcare (46.8%), and improved quality of care (29.8%). The main barriers to TM were the lack of clear legislation (47.8%) and fnancial compensation (17.4%). Clinicians and patients identifed common barriers to effective tele-rheumatology as the inability to perform a physical exam (91.3% vs 33.3%), the fear of trivializing the disease (34.8% vs 36%), and the lack of resources and infrastructures (43.5% vs 29.3%). The majority of the doctors (86.2%) expressed their willingness to attend training workshops. Reported areas to apply TM according to the doctors were mainly osteoarthritis (76.3%) and rheumatic diseases (64.4%), but also pediatric rheumatology (28.8%) and undiagnosed new patients (3.4%). Regarding legislation, most of practitioners estimated that it should be selective with specifc authorizations (42.4%) or relaxed with the possibility of derogation (32.2%). Twenty-two percent of them reported that legislation should be strict with the possibility of sanctions, whereas a minority (3.4%) opted for a free practice without regulation at all. Factors associated with adherence to TM were age<40 years (p=0.036) for doctors and familiarity with the concept (p=0.006) and electronic devices afforded (p=0.000) for the patients. Conclusion: Findings from this study showed the reluctance of the patients to adhere to TM compared to doctors. Concerns and risks may lessen for both sides, once remote consultations are applied. Nevertheless, patient education is required for the success of TM application.