Telemedicine feasible for delivery of SLE follow-up care
medwireNews: Telemedicine might be equally effective to standard in-person follow-up for maintaining disease control in systemic lupus erythematosus (SLE) patients in the short term, with good levels of patient satisfaction, suggests a 6-month randomized controlled trial.
However, it might need to be supplemented with in-person visits over the longer term, Ho So (The Chinese University of Hong Kong) told delegates at the ACR Convergence 2021 virtual meeting.
Together with colleagues, he assessed the feasibility of telemedicine as a mode of delivery for maintaining disease control among 122 SLE patients attending a lupus nephritis clinic. Of these, 60 attended at least two telemedicine follow-ups via videoconferencing over a 6-month period while 62 attended at least two in-person outpatient visits. The average number of visits for both groups was three.
During the 6 months, a similar proportion of patients in each group remained in LLDAS, at a rate of 75.0% with telemedicine and 74.2% with in-person care, with no significant difference between the groups.
The Physician Global Assessment (PGA) score was significantly higher in patients receiving telemedicine compared with in-person care at baseline (0.67 vs 0.45 points) and remained significantly so at the most recent visit (0.52 vs 0.36), whereas there was no significant difference on the SLEDAI -2k at baseline (4.00 vs 3.30) or follow-up (3.58 vs 3.47).
There was also no significant difference in the mean 24-hour proteinuria level or prednisolone dose between the two groups at the last visit.
Moreover, telemedicine was well received by patients, with the patient satisfaction scores higher overall in the telemedicine than the in-person care group, as well as for the consultation and explanation of medication use and side effects, specifically.
So noted that this improved patient satisfaction “could be driven by the shorter pre-consultation waiting time,” which were significantly reduced with telemedicine, from 68.9 minutes with in-person care to 22.5 minutes, or “the logistic convenience of telemedicine.”
Telemedicine was associated with a significantly higher rate of hospitalizations than in-person care, So highlighted, at 25.0%, compared with 11.3% with in-person care, although rates of hospitalization relating to SLE were similar and the difference in overall rates was no longer significant after accounting for baseline PGA.
This finding, along with a higher tendency for patients receiving telemedicine to request a change to in-person care, at 20%, compared with 8.1% wanting to change from in-person to telemedicine, “could off-set the conceived advantages of telemedicine,” suggested So.
The main reasons for such a request among those receiving telemedicine were perceived flares and new symptoms. By comparison, fear of contracting SARS-CoV-2 was the main reason for requesting a change to telemedicine.
So therefore concluded that “telemedicine might be equally efficacious in maintaining the disease control in patients with lupus nephritis in [the] short-term, although it might need to be supplemented by in-person visits.”
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