Abstract
Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.
Highlights
IntroductionWhile increasingly effective treatments are being developed, the number of newly registered rheumatologists is stagnating [2] and the global demand for rheumatologists is not being met [3]
The global burden of rheumatic and musculoskeletal diseases (RMDs) is rising [1].While increasingly effective treatments are being developed, the number of newly registered rheumatologists is stagnating [2] and the global demand for rheumatologists is not being met [3]
To explore opportunities and barriers of telerheumatology implementation, an exploratory, participatory, mixed-methods study design [28] was used (Figure 1). It consists of complementary data from (1) expert interviews with patients and professional stakeholders in rheumatology care, (2) a national, paper-based RMD patient survey, and (3) patient and rheumatologist focus groups
Summary
While increasingly effective treatments are being developed, the number of newly registered rheumatologists is stagnating [2] and the global demand for rheumatologists is not being met [3]. The deficit of rheumatologists has led to diagnostic delays in many diseases [4] and a decline in treatment effectiveness [5]. “[T]he practice of medicine over a distance, in which interventions, diagnoses, therapeutic decisions, and subsequent treatment recommendations are based on patient data, documents and other information transmitted through telecommunication systems” [12]. Opportunities of telemedicine are numerous [13] and have been demonstrated in multiple medical domains [14], an example of which is cardiology care: Telemedicine support may help to overcome diagnostic delays [15] and even reduce mortality in heart failure [16]. Telemedicine can increase the efficiency of health care, shorten travel distances, facilitate access to health care services [17], and might reduce socioeconomic barriers [18]—aspects that are discussed as potentials of telemedicine in rheumatology care (telerheumatology) [19,20,21,22]
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