By Erich Martin
Telemedicine offers the promise of increased efficiency during patient care, but in-person evaluations and relationships are too valuable to completely disregard, according to a debate session at EULAR 2022 Congress.
“The treat-to-target recommendations say that we should see patients regularly, especially when they have active disease, they should be seen quite frequently,” Christian Dejaco, MD, PhD, MBA, of the Medical University of Graz, in Austria, said during the virtual meeting. “Unfortunately, that is not the case in clinical practice. Telemedicine might be one of the options that could help us to improve this situation.”
Beginning at the start of a patient’s journey for treatment, Dejaco argued that telemedicine could make pre-diagnostic assessments more efficient.
“We could, in the first telemedicine visit or assessment, also recommend the right exams to a patient, or, when it is seen, that it is definitely not a rheumatology patient, they can be directed to another specialty,” Dejaco said.
After the initial diagnostics and necessary patient redirection, telemedicine can also increase the efficiency of moderating patients’ disease activity.
“Telemedicine might also help during follow-up to keep the standards of treat-to-target and to regularly monitor the patients and also to react when something is not going how it should be,” Dejacio said.
In that vein, telemedicine offers rheumatologists the opportunity to quickly and efficiently monitor and assist patients dealing with minor disease flares, according to Dejaco.
Finally, regular telemedicine visits may aid in improving therapy adherence and give physicians the opportunity to offer counsel on non-pharmacological interventions such as diet and exercise at regular intervals.
“Telemedicine would also help us to improve the adherence to drugs and to give patients some other recommendations for everything else around the disease,” Dejaco said. “When you explain it once during a face-to-face visit, they may understand, but when they are at home, they forget almost everything you have said, and they may have concerns and not always adhere to your treatment, but it works much better when there is someone calling the patient 1 or 2 weeks after the visit and explaining again.”
Meanwhile, Robert B.M. Landewé, MD, PhD, of Amsterdam UMC, in The Netherlands, and chairman of the EULAR committee for Quality of Care, argued that, in contrast to the efficiency offered by telemedicine, in-person rheumatology appointments offer patients and physicians the types of long-term relationships and trust that is required for sustained care.
“Patients, as well as doctors, are interested in long-term relationships,” Landewé said. “They are interested in long-term relationships with durations of at least 30 years,” he added. “It is all about patient satisfaction. It is far more about care than about cure.”
“I mentioned the word ‘communication’ already quite a few times,” he added. “It is about the impact of communication in health care. Extensive research has shown that no matter how knowledgeable a clinician might be, if he or she is not able to offer good communication with a patient, he or she may be of no help to that patient.”
Landewé said, telemedicine is “an exchanging of parcels of information,” in contrast to in-person visits, which offer physicians the opportunity to socialize with patients while showing compassion. Additionally, in-person visits give physicians the chance to offer explanations and have discussions with patients about potential therapies.
“Telemedicine impoverishes the quality of communication,” Landewé said. “Because it is nothing more than exchanging parcels of information.”