Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory Mixed-Methods-Study (Preprint)

Abstract

The global burden of rheumatic and musculoskeletal diseases (RMDs) is rising. Professional ressources in rheumatology are scarce. The use of telemedicine could improve access to RMD care. Despite all its promises, telemedicine is still not widely implemented in RMD care.

To investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders involved in RMD patient management.

From November 2017 to December 2019 a participatory mixed-methods-study was conducted based on three parts: (1) qualitative expert interviews with RMD patients and professional stakeholders that were used to participatively design (2) a national paper-based patient survey. The survey results were hence discussed in (3) focus groups with patient representatives and rheumatologists.

Fifteen patients and 26 professional stakeholders participated in the qualitative and further 766 patients took part in the quantitative research. The qualitative interview data reveals opportunities and barriers from the patients' (n=5) and professional stakeholders’(n=23) perspectives: Patients appreciate the potentials of telemedicine to overcome space and time in health care. In contrast, the loss of personal patient-doctor contact is the main concern of patients regarding telemedicine use. Personal contact is equated with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient-doctor relationship. Professional stakeholders expect telemedicine to contribute to effective allocation of scarce resources in rheumatology care. This is countered by the absence of physical examinations and organizational challenges as barriers of the use of telemedicine. Both, patients and professional stakeholders describe telemedicine as something broad and complex to define. These qualitative findings align with the survey results: 38% (264/690) of the surveyed patients refuse to try telemedicine, 32% (216/690) are not sure, and 30% (210/690) would like to try telemedicine. ‘No personal contact with the doctor’ (64%, 220/346) was most frequently chosen as a reason against telemedicine, followed by ‘Data security’ (28%, 96/346). Patients prefer to use the telephone (60%, 206/341) over video-consultations (35%, 118/341) as telemedicine use cases. Only 2 (0.3%, 2/714) survey participants indicated that they already had a video consultation with their physician. The focus groups revealed a homogeneous spectrum of opinions with participants confirming the survey results. Patients (n=10) emphasize the high relevance of physical doctor-patient contact. Rheumatologists (n=4) highlight the potential of telemedicine, as a support of existing care structures. However, the exact integration of telemedicine into medical routines remains unclear, especially in view of scarce time resources in rheumatology care.

As digital transformation of rheumatology care progresses, the desire for a close patient-doctor relationship persists. Many study participants fear that the use of telemedicine will have negative effects on patient-doctor relationship and therefore oppose the use of telemedicine. We identified further barriers and opportunities, such as information needs, digital infrastructure and equipment requirements, and patient preferences on the composition of digital services, to guide the design and implementation of telemedicine in rheumatology care.