Patient self-assessment and virtual visit-based treatment decisions in rheumatoid arthritis: results from the multicentre Telemedicine in Rheumatoid Arthritis trial.

OBJECTIVES

The growing shortage of rheumatologists threatens rheumatology care. Patient self-assessment and asynchronous virtual visits may improve efficiency. This study assessed the concordance of face-to-face (F2F) and virtual visit-based treatment decisions in individuals with rheumatoid arthritis (RA), incorporating patient self-assessment.

METHODS

This prospective 3-month multicentre trial recruited RA patients across 4 university centres in Germany. Patients used a medical app to document the results of a self-performed C-reactive protein (CRP) test, joint count, therapeutic suggestions, and electronic patient-reported outcomes (ePROs) before their regular F2F consultations and ePROs on a weekly basis in-between consultations. Independent tele-rheumatologists provided treatment recommendations based on these data. The primary outcome was the level of agreement between tele-rheumatologists and patients on treatment decisions (escalation, unchanged, de-escalation), compared with F2F rheumatologists' decisions. Secondary outcomes included change in patient activation (Patient Activation Measure [PAM]) and in patient-perceived ability to assess their disease activity.

RESULTS

A total of 208 consultations and 114 patients (80.7% female, mean age 51.6 years) were included. Most often (63%), treatment remained unchanged, whereas 24% required escalation and 14% de-escalation. F2F treatment decisions aligned with tele-rheumatologist decisions in 77% of cases and patient suggestions in 67% of cases. The accuracy of tele-rheumatologist decisions was 77% for maintaining treatment, 87% for de-escalation, and 91% for escalation. No significant changes in patient activation and patients' ability to assess their disease activity were observed.

CONCLUSIONS

The study demonstrated substantial agreement between virtual asynchronous and F2F treatment decisions. However, further refinement of asynchronous care models and validation studies is crucial.