The COVID-19 pandemic has changed the nature of patient-doctor relationships for people with rheumatoid arthritis (RA).
Concern about exposure to the new coronavirus has understandably made people more reluctant to book in-person doctor’s office visits. As a result, doctors have increasingly looked for innovative ways to connect with their patients without sacrificing quality care.
Telehealth and telemedicine have become some of the primary ways to interact with your doctor during the pandemic.
And it’s a model of care that’s likely to remain after the COVID-19 crisis subsides, as long as insurers continue to reimburse for post-pandemic virtual visits.
The concept of telehealth and telemedicine isn’t new. Initially, these terms referred mostly to healthcare delivered via telephone or radio. But their meaning has expanded greatly as of late.
Telemedicine refers to diagnosing and treating patients via telecommunication technology, including the phone and internet. It typically takes the form of video conferencing between patients and doctors.
Telehealth is a broader category that goes beyond clinical care. It includes all aspects of remote health services, including:
- the use of mobile health apps
- wearable devices to collect health data
- online health education
- sharing of health information among healthcare providers
Telemedicine has long been used in rural settings where people don’t have easy access to medical specialists. But before the COVID-19 pandemic, the broader adoption of telemedicine was hampered by issues like:
- confidentiality concerns
- licensing requirements
- administrative costs
- the reluctance of insurers to cover telemedicine visits
Rheumatologists also have previously been reluctant to substitute telemedicine for in-person visits because it prevents the physical examination of joints. This examination is an important part of assessing people with conditions like RA.
In response to the need for more telemedicine during the pandemic, however, federal health officials have worked to remove some of the barriers to telemedicine. This is particularly true around the issues of licensing and reimbursement.
As a result of these changes and the demand for remote care due to the COVID-19 crisis, more rheumatologists are offering telemedicine visits.
A 2020 Canadian survey of adults with rheumatic diseases — half of whom had RA — found that 44 percent had attended a virtual clinic appointment during the COVID-19 pandemic.
And the 2020 Rheumatic Disease Patient Survey conducted by the American College of Rheumatology (ACR) found that two-thirds of respondents had a rheumatology appointment via telehealth.
In about half of those cases, people were compelled to get virtual care because their doctors were not scheduling in-person office visits due to the COVID-19 crisis.
Yes — with some caveats.
The COVID-19 pandemic has accelerated adoption of telemedicine in rheumatology. Research shows that the most effective use of telemedicine is monitoring people who are already diagnosed and living with RA.
A 2020 study of Alaska Native people with RA found no difference in disease activity or quality of care between those who received care in person or via telemedicine.
And according to the previously mentioned Canadian survey, 71 percent of respondents were satisfied with their online consultation. This suggests that the majority of people were comfortable with remote care for conditions like RA.
Virtual care cannot fully take the place of in-person care, however.
In a recent position paper on telemedicine, the ACR said that it “supports the role of telemedicine as a tool with the potential to increase access and improve care for patients with rheumatic diseases, but it should not replace essential face-to-face assessments conducted at medically appropriate intervals.”
You should see your doctor in person for any musculoskeletal exams needed to diagnose a new condition or to monitor changes in your condition over time.
“Some disease activity measures, especially those dependent on physical exam findings such as swollen joint counts, cannot be easily measured by patients remotely,” the ACR said in the aforementioned position paper.
The first thing you’ll need for a telemedicine visit for RA is a way to communicate with your physician.
For visits requiring audio only, you’ll just need a phone.
For visits that require examinations via video, you’ll need a smartphone, tablet, or computer with a microphone, webcam, and teleconferencing software. You’ll also need a good internet connection or Wi-Fi.
For video appointments, your doctor may email you a link to a secure online patient portal, where you can have a live video chat, or a link to connect via an application like:
- Facebook Messenger
- Google Hangouts
Before you log in for your appointment, other steps you can take to prepare for an RA telemedicine visit include:
- making sure the visit is covered by your insurance
- filling out any required pre-exam questionnaires or paperwork
- writing down your questions for the doctor
- considering your goal for the visit
- compiling a list of all current medications and supplements
- having pen and paper available to take notes
- finding a quiet, well-lit place to conduct the visit
In many ways, a telemedicine visit for RA will be similar to an in-person appointment with your doctor.
You’ll discuss your current symptoms, medications, and overall well-being with your physician.
You also may be asked to show your doctor any joint swelling you’re experiencing via video, so be sure to wear loose-fitting clothing during your virtual visit.
Depending on your symptoms and the medications used, you may need to schedule a follow-up, in-person exam with your healthcare provider.
You also may be able to use your doctor’s secure patient portal to ask questions between visits.
And of course, be sure to fill any prescriptions and follow directions regarding medication use. You should also keep up with any physical therapy, just as you would after a “normal” visit.
Telehealth has become an increasingly popular way to access care for RA during the COVID-19 pandemic.
Conducted by phone or over the internet, telemedicine visits can be especially useful for monitoring RA symptoms.
An in-person visit may still be necessary, however, when doctors need to physically examine your joints, bones, and muscles.