Patient self-assessment and virtual visit-based treatment decisions in rheumatoid arthritis: results from the multicentre Telemedicine in Rheumatoid Arthritis trial

<h2>ABSTRACT</h2><h3>Objectives</h3> The growing shortage of rheumatologists threatens rheumatology care. Patient self-assessment and asynchronous virtual visits may improve efficiency. This study assessed the concordance of face-to-face (F2F) and virtual visit-based treatment decisions in individuals with rheumatoid arthritis (RA), incorporating patient self-assessment. <h3>Methods</h3> This prospective 3-month multicentre trial recruited RA patients across 4 university centres in Germany. Patients used a medical app to document the results of a self-performed C-reactive protein (CRP) test, joint count, therapeutic suggestions, and electronic patient-reported outcomes (ePROs) before their regular F2F consultations and ePROs on a weekly basis in-between consultations. Independent tele-rheumatologists provided treatment recommendations based on these data. The primary outcome was the level of agreement between tele-rheumatologists and patients on treatment decisions (escalation, unchanged, de-escalation), compared with F2F rheumatologists' decisions. Secondary outcomes included change in patient activation (Patient Activation Measure [PAM]) and in patient-perceived ability to assess their disease activity. <h3>Results</h3> A total of 208 consultations and 114 patients (80.7% female, mean age 51.6 years) were included. Most often (63%), treatment remained unchanged, whereas 24% required escalation and 14% de-escalation. F2F treatment decisions aligned with tele-rheumatologist decisions in 77% of cases and patient suggestions in 67% of cases. The accuracy of tele-rheumatologist decisions was 77% for maintaining treatment, 87% for de-escalation, and 91% for escalation. No significant changes in patient activation and patients' ability to assess their disease activity were observed. <h3>Conclusions</h3> The study demonstrated substantial agreement between virtual asynchronous and F2F treatment decisions. However, further refinement of asynchronous care models and validation studies is crucial.