Move to telehealth has delayed rheumatology diagnoses: study

Telerheumatology during the pandemic may have had a negative impact on the timeliness of management of rheumatology patients.

The conclusion comes from a retrospective audit of COVID-19 telerheumatology appointments at Monash Health in April-May 2020 and pre-pandemic appointments in a comparison cohort from April-May 2019.

Inflammatory arthritis was the most common diagnosis in both cohorts but higher in 2020 than 2019 (35.1% v 31%; p=0.024).

The study of more than 3,000 appointments found that in patients without an existing rheumatological diagnosis, the odds of making a diagnosis were significantly lower by telehealth in 2020 than face to face in 2019 (28.6% vs 57.4%; OR 0.30; p<0.01).

Clinicians were less likely to change immunosuppressive therapy in 2020 (22.6% vs 27.4%; OR 0.78; p=0.004) which appeared mostly driven by less de-escalation in therapy (10% vs 12.6%; OR 0.75; p=0.019).

“This may suggest a preference to minimise the risk of flares and avoid rescue immunosuppression, or the inability to confidently assess disease activity via telerheumatology,” the study authors said.

Non-attendance at appointments fell from 10.9% in 2019 to 6.5% in 2020 and the odds of discharging a patient were lower in 2020 (3.9% vs 6%; OR 0.64; p=0.008).

“Unplanned hospital presentations and planned admissions were reduced in 2020 (p<0.05), mirroring lower presentation rates to Australian emergency departments during the pandemic and in keeping with hospital attendance hesitancy due to concerns about hospital acquired transmission of COVID-19.”

“Patients seen in 2020 also required earlier follow-up appointments (p<0.001), which may relate to the inability to conduct a physical examination.”

“Predictors of needing a [face to face] F2F review were being a new patient (OR 6.28 [95% CI: 4.10-9.64]; p<0.001), not having a rheumatological diagnosis (OR 18.43 [95% CI: 2.35-144.63]; p=0.006), or having a diagnosis of IA (OR 2.85 [95% CI: 1.40- 5.80]; p=0.004) or lupus/CTD (OR 3.22 [95% CI: 1.11-9.32]; p=0.031).”

“While the effects of telerheumatology cannot be differentiated from changes in practice related to the pandemic, these findings suggest telephone-based telerheumatology may have a negative impact on the timeliness of management of rheumatology patients,” the authors concluded.

The study was published in Rheumatology.

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