Telemedicine should be integrated into the current system as a routine service option for stable patients with SLE.
The pandemic compelled medical professionals to stretch beyond conventional means to provide care to their patients. A primary example of this is the adoption of telemedicine. Patients with disease states such as systemic lupus erythematosus(SLE) experience a greater risk for severe COVID-19 infection and may, therefore, benefit from the socially distanced care provided by telemedicine.
Because the effectiveness of this mode of care lacked abundant evidence, Ho So, MBBS, MRCP, MSc, and colleagues conducted a 1-year randomized controlled trial comparing telemedicine with traditional in-person care among patients with SLE. The findings were published in the Journal of Telemedicine and Telecare. Physician’s Weekly discussed this research with Dr. So.
PW: Why did you feel this topic needed exploration?
Dr. So: Medical care of patients with SLE during the pandemic was severely interrupted. Despite the lack of experience and evidence, telemedicine has been widely practiced as an alternative mode of care delivery. Research investigating the effectiveness and safety of telemedicine was urgently needed. A complete societal lockdown was not implemented in Hong Kong, thus a clinical trial comparing telemedicine and in-person care was feasible.
What are the most important findings from your study for physicians to understand?
In a pragmatic trial setting, at 1 year, SLE disease activity was similar in patients randomized to telemedicine and standard follow-up groups. There were no differences in the costs of illness, QOL, or mental health scores between the two groups. Patients in the telemedicine group had better satisfaction scores. However, significantly more patients in the telemedicine group required a switch in their mode of follow-up, and a higher proportion of these had hospitalization. Not being in low disease activity at baseline was predictive of hospitalization (Table).
What do practicing physicians need to know about the efficacy of using telemedicine in their practice?
Telemedicine-delivered care used alongside traditional in-person care can help maintain disease activity control and psychosocial well-being in patients with SLE, as witnessed during the COVID-19 pandemic. However, telemedicine cannot wholly replace in-person visits, particularly in patients with unstable disease.
How can telemedicine be used beyond the scope of the pandemic?
Telemedicine definitely has logistic advantages for patients and can probably help relieve stress from the already strained healthcare system. It should be incorporated into the current system as a routine service option for stable SLE patients.
What would you like future research to focus on?
The exact efficacy and safety of a hybrid mode of follow-up in SLE care should be explored. Development and validation of patient-reported outcomes in SLE should be analyzed. The role of remote monitoring gadgets should also be considered as part of a complete medical care plan. It will also be important to evaluate whether telemedicine has the potential to worsen health disparity.
Is there anything else that you feel Physician’s Weekly readers would benefit from knowing about your research?
Telemedicine is useful and here to stay, even for patients with complex diseases like SLE. We need better research, hardware, systems, and education to make the best use of it.
