Patient-led follow up with an asynchronous service ‘significantly and clinically’ reduced rheumatology visits.
Patients with spondyloarthritis needed fewer rheumatology visits when they engaged with patient-led telemedicine instead of usual care, according to a recent Dutch study.
“Patient-initiated follow-up and asynchronous telemedicine resulted in significant and clinically meaningful reductions in rheumatology visits,” the authors wrote in The Lancet Rheumatology. “This was not at the expense of health outcomes and saved health-care costs.”
Previous research found routine follow-up visits at 3-6 months were considered unnecessary in spondyloarthritis patients who were stable. This was particularly important in the context of rising healthcare costs and potential workforce shortages, the authors said.
To determine whether patient-driven visits could offer an alternative approach, the researchers randomly assigned 200 patients to receive either usual care or self-directed and asynchronous telemedicine when the patient wanted it.
Patients in the usual care arm were followed up at baseline and after 12-months, with more visits at their rheumatologist’s discretion, while patients in the telemedicine group answered a questionnaire at six months, and could ask for a phone or in-person appointment instead if they preferred.
At one year, patients in the telemedicine group had an average of 1.9 rheumatology visits, compared to 2.6 in the control group. An adjusted analysis found that on-demand care was also cheaper to the healthcare system, without sacrificing quality-adjusted life-years.
“Considering the anticipated rise in health care demand together with declining resources, time for synchronous care will become increasingly scarce,” the authors wrote.
“This study shows that patient-initiated follow-up supported by telemedicine can reduce the need for consultations in patients with stable disease, which could lead to increased accessibility for other patients. “
“In an era of declining availability of health-care personnel and rising health-care costs, patient-initiated follow-up and asynchronous telemedicine could be a valuable approach for the follow-up of patients with stable spondyloarthritis.”
The approach wasn’t totally without risk, the authors noted.
Patients could be lost to follow-up, experience delayed care and not recognise when they needed medical attention. Patients in this group did have more visits to non-rheumatology healthcare services.
Nevertheless, secondary outcomes such as physical functioning, quality of life and number of flares were similar across groups, as were other patient reported outcomes. Most of the patients, who were 55 years old on average, were favourable to the patient-initiated approach.
“There was no relevant between-group difference regarding biological DMARD use.”
“Approximately three-quarters of patients in the intervention group agreed with statements that patient-initiated follow-up and asynchronous telemedicine saved time and was a flexible approach to follow-up.”
