Telemedicine in rheumatology: a mixed methods study exploring acceptability, preferences and experiences among patients and clinicians

Abstract

Objectives: The Covid-19 pandemic necessitated a rapid global transition towards telemedicine; yet much remains unknown about telemedicine's acceptability and safety in rheumatology. To help address this gap and inform practice, this study investigated rheumatology patient and clinician experiences and views of telemedicine.

Methods: Sequential mixed methodology combined analysis of surveys and in-depth interviews. Between and within-group differences in views of telemedicine were examined for patients and clinicians using t-tests.

Results: Surveys (patients n = 1340, clinicians n = 111) and interviews (patients n = 31, clinicians n = 29) were completed between April 2021 and July 2021. The majority of patients were from the UK (96%) and had inflammatory arthritis (32%) or lupus (32%). Patients and clinicians rated telemedicine as worse than face-to-face consultations in almost all categories, although >60% found it more convenient. Building trusting medical relationships and assessment accuracy were great concerns (93% of clinicians and 86% of patients rated telemedicine as worse than face-to-face for assessment accuracy). Telemedicine was perceived to have increased misdiagnoses, inequalities and barriers to accessing care. Participants reported highly disparate telemedicine delivery and responsiveness from primary and secondary care. Although rheumatology clinicians highlighted the importance of a quick response to flaring patients, only 55% of patients were confident that their rheumatology department would respond within 48 hours.

Conclusion: Findings indicate a preference for face-to-face consultations. Some negative experiences may be due to the pandemic rather than telemedicine specifically, although the risk of greater diagnostic inaccuracies using telemedicine is unlikely to be fully resolved. Training, choice, careful patient selection, and further consultation with clinicians and patients is required to increase telemedicine's acceptability and safety.

Trial registration: This telemedicine study is part of a pre-registered longitudinal multi-stage trial, the LISTEN study (ISRCTN-14966097), with later Covid-related additions registered in March 2021, including a pre-registered statistical analysis plan.

Keywords: digital technology in medicine; mixed-methods; pandemic; patient–physician interactions; rare autoimmune rheumatic diseases; rheumatology; telemedicine.

Fig. 1

Views of telemedicine compared with F2F – medical relationships and assessment accuracy (a) Views on telemedicine compared with face to face – relationship building and appointment anxiety (n = 1340 patients, n = 111 clinicians). (b) Views on telemedicine compared with face to face – accuracy of diagnoses and symptom reporting (n = 1340 patients, n = 111 clinicians). Note: T-tests comparing means of ratings from 1 (much worse) to 5 (much better) from clinicians and patients regarding views of telemedicine compared to F2F. MD: mean difference between scores of patients and clinicians assessed by t test. If P > 0.05, it is reported as non-significant.

Fig. 2

Views of telemedicine compared with F2F—Convenience and time (a) Views on telemedicine compared with face to face – convenience and time (n = 1340 patients, n = 111 clinicians). Note: T-tests comparing means of ratings from 1 (much worse) to 5 (much better) from clinicians and patients regarding views of telemedicine compared to F2F. MD: mean difference between scores of patients and clinicians assessed by t test. If P>0.05, it is reported as non-significant. (b) Common clinician views of advantages and disadvantages of telemedicine for convenience.

Fig. 3

Preferences for mode of appointment delivery (a) Preferences for proportion of appointments between telemedicine and F2F (n=1337 patients, n=111 clinicians). Note: Hospital management preferences are as reported by clinicians. (b) Preferences for mode of telemedicine delivery (n= 1340 patients, n = 111 clinicians). (c) Example quotes of clinicians’ conflicting views with management.