Telemedicine Use among Patients with Rheumatoid Arthritis: Identification of Motivational Determinants based on Data from a Nationwide Survey in Germany (Preprint)

Abstract

Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases (RMD) to use TM are closely connected to their disease. Yet, it is still unclear which factors are associated with patients’ motivation to use TM among specific RMD groups, such as rheumatic arthritis (RA).

This study aimed to identify factors that determine the willingness to try TM (TM-try) among patients diagnosed with RA.

We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data in order to determine which factors were associated with TM-try. Predictor variables (covariates) studied individually included sociodemographic factors (e.g., age, sex) and health characteristics (e.g., health status). All the variables positively and negatively associated with TM-try in the univariate analyses were then considered for Bayesian model averaging analysis (BMA) after a selection based on the variance inflation factor (≤ 2.5) to identify determinants of TM-try.

A total of 22 variables/factors (22/55, 40%) were found to be positively or negatively associated (ROPE% ≤ 5%) with TM-try among 146 RA patients. A total of 9 determinant factors were identified using BMA. Wishing that TM services were offered by a rheumatologist, having prior TM knowledge, living in a town and considering one’s health status as moderate were positively associated with TM-try. By contrast, not owning a TM-ready technical equipment, not having internet access at home, considering to have a bad health status and being more than 60 years old were negatively associated with TM-try.

Our results suggest that health status, TM knowledge, age, and access to technical equipment and infrastructure influence RA patients' motivation to use telehealth. In particular, older patients with RA with a bad health status are not motivated to use TM and might be left out from digital transition in rheumatology care.