• quality indicators, health care
• outcome assessment, health care
• outcome and process assessment, health care

We read with interest the letter published by Bozzalla Cassione et al,1 in which authors evaluated 165 patients with systemic lupus erythematosus using telemedicine as the follow-up method. As in Italy, the high infectivity and the risk of collapse of intensive care units led to the Spanish government to announce on 14 March the strict confinement and prohibition of social mobility to ensure a decrease in COVID-19 contagion rates. As a consequence, physical consultations of rheumatology outpatients have been replaced by phone consultations to prevent the risk of contagion.2 One of the most important concerns that limits the care quality of rheumatic patients in Spain is the pressure of healthcare, since the number of patients is excessive and human resources are limited. This epidemic outbreak has proven to be a great opportunity to test phone consultations in assisting rheumatic patients. The rheumatology department of Reina Sofía University Hospital in Córdoba (Spain) conducted a survey among rheumatic patients that was disseminated via patient organisations and social media throughout the national territory between 25 April and 5 May. The objective of this survey was to evaluate the patients’ level of satisfaction with the phone consultation and the profile of patients who considered this type of consultation to be useful for future implementation.

In this survey, the following data were collected: sex, age, diagnosis, current treatment and disease status (pain, stiffness, fatigue and depression in visual analogue scales ranging from 0 to 100). We also asked patients whether they underwent a phone consultation with their rheumatologist during the pandemic, the patients’ level of satisfaction with this consultation (0–100 scale) and their opinion of the utility of phone consultation in the future.

On 5 May, a total of 644 patients completed the survey, of which 244 (37.9%) underwent a phone consultation during confinement. The mean level of satisfaction of this consultation was 64.7±35.8. Among the 244 patients who received a phone consultation, 220 patients answered the following question: ‘Do you think that phone consultation could be useful in the monitoring of your rheumatic disease?’. A total of 116 (52.7%) opined ‘yes’ and 104 (47.3%) answered ‘no’. The characteristics of patients who considered the phone consultation to be useful in comparison with those who thought that would not be useful are shown in the table 1.

These results showed that neither gender nor age were associated with good acceptance of phone consultation, although young patients showed a trend towards better satisfaction with this type of assistance. We also found a similar prevalence of diagnosis between patients who considered useful phone consultation and those who did not. We expected to find that patients under biological disease-modifying antirheumatic drugs would be more prone to feeling unsatisfied with a phone consultation due to their need for tight control of their disease; however, interestingly, there were no differences in opinions on phone consultations with regard to treatment intake. The only difference found between satisfied and unsatisfied patients was the level of symptomatology. Patients who considered the phone consultation to be useful showed lower levels of axial pain (52.4±32.8 vs 63.7±29.8), peripheral stiffness (47.2±29.4 vs 56.1±29.0) and axial stiffness (47.6±32.7 vs 62.1±29.5) than did patients who did not find it useful.

Based on this survey, it seems that there is no specific profile of patients who considered a phone consultation to be useful, since neither the diagnosis nor the treatment intake was associated with this opinion. However, these results suggest that the status of the disease in terms of activity is the most important factor in patients’ acceptance of a phone consultation for their monitoring; to a lesser extent, young age was another important factor. The results from this survey will be helpful in the design of a model of telemedicine for patients with chronic rheumatic diseases, in which on-site consultation could be alternated with phone supervision during periods of low disease activity.