Objective: Telehealth has been proposed as a safe and effective alternative to in-person care for rheumatoid arthritis (RA). The purpose of this study was to evaluate factors associated with telehealth appropriateness in outpatient RA encounters.
Methods: A prospective cohort study (1/1/21-8/31/21) was conducted using electronic health record data from outpatient RA encounters in a single academic rheumatology practice. Rheumatology providers rated the telehealth appropriateness of their own encounters using the Encounter Appropriateness Score for You (EASY) immediately following each encounter. Robust Poisson regression with Generalized Estimating Equations (GEE) modeling was used to evaluate the association of telehealth appropriateness with patient demographics, RA clinical characteristics, comorbid non-inflammatory causes of joint pain, previous and current encounter characteristics, and provider characteristics.
Results: During the study period, 1,823 outpatient encounters with 1,177 unique RA patients received an EASY score from 25 rheumatology providers. In the final multivariate model [Relative Risk (95% Confidence Interval)], factors associated with increased telehealth appropriateness included higher average provider preference for telehealth in prior encounters [1.26 (1.21-1.31)], telehealth as the current encounter modality [2.27 (1.95-2.64)], and increased patient age [1.05 (1.01-1.09)]. Factors associated with decreased telehealth appropriateness included moderate [0.81 (0.68-0.96)] and high [0.57 (0.46-0.70)] RA disease activity and if the previous encounter were conducted via telehealth [0.83 (0.73-0.95)].
Conclusion: In this study, telehealth appropriateness was most associated with provider preference, the current and previous encounter modality, and RA disease activity. Other factors like patient demographics, RA medications, and comorbid non-inflammatory causes of joint pain were not associated with telehealth appropriateness.