The COVID-19 pandemic has dramatically changed the way routine, outpatient healthcare is provided, with the majority of consultations being conducted virtually during the peak of the pandemic as well as to date. It is likely that telemedicine is going to remain as standard practice from now onwards where appropriate and, as such, research is required to identify its efficacy compared an in-clinic consultations, cost considerations as well as the optimal technological modalities required for its long-term implementation. Although virtual consultations were a requirement during the peak of the pandemic to minimise infection risk for patients, many potential long-term benefits exist, such as improved convenience for patients with reduced travel time and time off work, and potentially reduced costs to healthcare providers [5, 6]. Some disadvantages, however, include potential difficulties building rapport between patients and healthcare providers as well as difficulty with accurate clinical assessments in patients with active disease. For the latter, video-consultations are preferable over telephone consultations though the possibilities for examination remains limited.
Most studies on the utility of telemedicine in rheumatology have surveyed rheumatologists rather than patients. To date, a small number of patient perspective studies on the use of telemedicine amongst patients with rheumatological disorders include predominantly patients with rheumatoid arthritis . We report the widespread use of telemedicine by patients with PsA during the COVID-19 pandemic across various centres in the UK, with the majority of virtual consultations taking place via telephone.
Although patients had reported the preferred method of contact as telephone, free text responses suggested that video appointments could allow better assessment of symptoms. Although the different aspects which constitute an ‘effective’ consultation are broad and likely variable between individuals, on the whole patients felt that if their disease was well-controlled virtual consultations were an adequate modality of clinical assessment. Patient satisfaction was situation dependent, and patients noted a preference for a physical examination, especially if disease was active. A larger survey, which also recruited predominantly patients with RA from North America also noted higher satisfaction with a virtual appointment if well controlled disease, with lower satisfaction if mild or moderate disease. Preference for video consultations was also mixed, with 43% expressing a preference for video appointments, while 43% had no preference . A further study from Poland noted that telemedicine (predominantly by telephone) expressed doubts over the value of telemedicine, reporting lack of examination, concerns about being able to explain symptoms and lack of ability to perform additional tests such as blood tests, which would ordinarily take place at the time of an in-clinic appointment. However, patients valued certain aspects of a traditional consultation which can be reproduced during a teleconsultation such as direct conversation with a doctor and communication of results .
There is likely to be some disparity between patient perspectives depending on their underlying disease. For example, studies in patients with systemic lupus erythematosus (SLE) have identified a more negative impact of virtual consultations compared to our survey, although objectives and study design differed .
Finally, the experience of patients designing and leading the survey project has been valuable, but not without challenges. MB and AP designed the survey questions, with contributions of BritPACT patient partners. Although both had experience of contributing to research and reviewing projects as patient participants or reviewers, neither had planned or led projects in their entirety, and acknowledge support from multiple people and organisations in design, distribution, and academic writing, and have gained new skills during the project.
In addition to giving insight of patients’ perspectives on the use of virtual consultations amongst those with PsA, this ‘patient driven e-survey’ raises the question of whether the survey design and implementation ‘by patients for patients’ allows for freer and more honest expression from respondents.
Some limitations of the survey include that clinical data on duration of disease was not identified and, as such, there may be some discrepancy in patient satisfaction of virtual consultations in newly diagnosed patients compared to those in whom treatment was already long-established. The latter group are more likely to have developed a rapport with their clinical team and therefore may feel more confident with their consultations being conducted virtually.
Furthermore, the survey was conducted electronically and shared by patient organisations and via social media. It is possible that responses are not fully representative of the UK population of patients with PsA, as patients with limited or no access to technology may have different views of telemedicine compared to those who are regular users of technologies. Additionally, the survey was only conducted in English and those with language- or perceived educational-barriers may not have participated and, due to the nature of survey distribution, we are unable to ascertain response rates compared to the number of patients who had access to the survey itself. As such, it is difficult to speculate whether patient-driven surveys are more likely to have higher response rates compared to surveys developed and distributed by healthcare professionals.
Due to the nature of the e-survey it was not possible to determine overall response rates and whether there were systematic differences in those who did/did not respond. Furthermore the survey was predominantly distributed to patients who are part of PsA networks or patient organisations and these patients may be more highly motivated with greater self-efficacy and involvement in their care; as such it may not accurately reflect views of the wider patient population. A wider survey taking these factors into account may yield different results and repeating a similar survey post-pandemic may be helpful to determine whether current perspectives on virtual consultations were affected by the necessity of this modality due to governmental restrictions rather than patient preference alone.
Patient-driven surveys may allow for more open responses from patients and questions written by patients may be better and more relevant in some topic areas as they are aware of the issues patients face first-hand; qualitative and quantitative research is required to review whether this is the case and increased experience of patient-driven surveys may enhance both aspects.