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Costa has raised a relevant question of switching to online platforms for maintaining continuity of medical care in patients with chronic rheumatic diseases (RDs).1 A near-total focus of healthcare systems on COVID-19, non-availability of medical consultations and medicines at some places, and delayed infusions have seriously undermined the care of chronic RDs. The unprecedented situation has heralded a felt need for a shift to virtual consulting, ranging from telephonic to instant messaging, email-based and video consultations.
In our survey, 114 of 221 (51.6%) rheumatologists in India had adopted virtual consultations in March 2020, with half of them (57) delivering patient care over WhatsApp, and 22.8% (26) and 27.1% (31) resorting to emails and video consultations.2 Merely 10% of physicians were continuing their clinics at the time of the survey. The choice of the platform might differ, with WhatsApp being more prevalent in certain countries like India and WeChat in China.3 The delivery of routine care on virtual platforms can prevent the need for travel and minimise personal and administrative costs towards healthcare. Such an approach assumes an even greater relevance in a country like India where a single rheumatologist is available for 40 352 patients with rheumatoid arthritis (RA) vs 1:425 in the USA (still considered to be inadequate).4 Despite the challenge of learning to operate different online software, the use of technology for patient consultations is rapidly gaining wider acceptance in these times.5 However, it is essential to be mindful of patient rights, including privacy, especially in light of the recent incidents of technological failure.6
Notably, Costa observed that the same treatment was continued in 89.5% of patients with psoriatic arthritis (psA), signifying that the renewal of prescriptions was the predominant requirement. At our unit we provided 199 teleconsultations (RA 31.6%, spondyloarthritis 15.6%) over the last fortnight, wherein over half (51.2%, 102) were advised to continue the same treatment, while routine investigations were awaited for another 8.5%. Admission was advised in 4.0%, immunosuppressants (IS) discontinued in 3%, and 3.5% were advised to start a new IS, respectively (table 1). Titration of the dose of IS and non-steroidal anti-inflammatory drugs (NSAIDs) for managing symptoms was required by one in five patients (20.6%, 41). Notably, certain RDs that may require closer monitoring (vasculitis and myositis) were underrepresented in the cohort but over-represented among admissions, the reverse being true for RA and spondyloarthritis. Thus, a triage algorithm based on the type of RD, disease activity, age, and comorbid conditions may be designed to prioritise medical care.
Besides, utility of teleconsultations in recent times could signal a shift towards patient-reported outcome measures in future. In countries with established infrastructure, linking the app-based services with the hospital information system can provide an organised record base of future reference.3 7 While the importance of real interaction and formal physical examination cannot be overemphasised, teleconsultations can tide over the crises. At the same time, logistics such as reimbursement can be sorted out at the federal level. Further, teleconsultation-based services have the potential to be extended to practitioners at the primary healthcare level by specialists placed at higher centres for guidance in the management of complex diseases when the patients cannot be referred due to travel restrictions.
Thus, the successful use of telemedicine for managing psA by Costa and recent insights at our centre argues for greater exploration of this digital tool for a decentralised approach towards seamless patient care.
Handling editor Josef S Smolen
Correction notice This article has been corrected since it published Online First. Reference 5 has been corrected.
Contributors All the authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. Final approval of the version published. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Patient consent for publication Not required.
Provenance and peer review Commissioned; internally peer reviewed.
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