Thiele Thea, Beider Sonja, Kühl Henrik, Mielke Gudrun, Holz Anna, Hirsch Stefanie, Witte Torsten, Hoeper Kirsten, Cossmann Anne, Happle Christine, Jablonka Alexandra, Ernst Diana
Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Rheumatologische Facharztpraxis, Hildesheim, Deutschland.
Z Rheumatol. 2022 Mar;81(2):157-163. doi: 10.1007/s00393-021-01005-3. Epub 2021 May 11.
Telemedicine was implemented in outpatient care during the lockdown between March and May 2020. The aim of the study was to assess patients from a private practice and the university outpatient department with respect to patient satisfaction with telemedicine, COVID-19 worries and vaccination behavior and to compare the teleconsultation by a medical assistant for rheumatology (RFA) and a physician.
Patients with rheumatoid arthritis, psoriatric arthropathy or spondylarthritis without treatment modifications since the previous presentation were offered a telemedical replacement appointment within the framework of this study in the case of appointment cancellation by the treating center. Participants were randomized to a telemedicine appointment by a physician or an RFA (RFA university only). The patient history was carried out by telephone and standardized using a questionnaire. The disease activity was determined using the modified clinical disease activity score (CDAI) and the BASDAI. Subsequently, all patients received a pseudonymized evaluation questionnaire.
In total 112/116 (96%) patients participated. Of these 88/112 (79%) returned the questionnaire. The RFAs conducted 19/112 (17%) of the telephone calls. The treatment was modified in 19/112 (17%) patients. Concerns about contracting COVID-19 correlated with high disease activity (p = 0.031) including the presence of painful joints (p = 0.001) and high pain levels (VAS ≥7, p = 0.009). These patients would have also cancelled their appointment themselves (p = 0.015). Patient satisfaction with the consultation was good (mean 4.3/5.0 modified FAPI) independent of the institution, the duration of the consultation and the consultation partner. Patients with a high pain intensity were the least satisfied (p = 0.036). Only 42/100 (38.2%) of the patients had been vaccinated against pneumococci and 59/100 (53.6%) against influenza.
Telemedical care within the framework of a telephone consultation is well-suited for selected patients. With respect to patient satisfaction the delegation of a telemedical consultation to an RFA is possible. There is a need for improvement with respect to the vaccination behavior.
2020年3月至5月封锁期间，远程医疗在门诊护理中得到应用。本研究的目的是评估来自私人诊所和大学门诊部的患者对远程医疗的满意度、对新冠病毒的担忧以及疫苗接种行为，并比较由风湿病医学助理（RFA）和医生进行的远程会诊。
自上次就诊以来治疗未改变的类风湿关节炎、银屑病关节炎或脊柱关节炎患者，若治疗中心取消预约，在本研究框架内为其提供远程医疗替代预约。参与者被随机分配接受医生或RFA（仅大学的RFA）的远程医疗预约。通过电话进行病史询问并使用问卷进行标准化。使用改良临床疾病活动评分（CDAI）和巴斯强直性脊柱炎疾病活动指数（BASDAI）确定疾病活动度。随后，所有患者都收到一份匿名评估问卷。
总共112/116（96%）名患者参与。其中88/112（79%）名患者返回了问卷。RFA进行了19/112（17%）的电话问诊。19/112（17%）名患者的治疗方案被修改。对感染新冠病毒的担忧与高疾病活动度相关（p = 0.031），包括存在疼痛关节（p = 0.001）和高疼痛程度（视觉模拟评分法[VAS]≥7，p = 0.009）。这些患者自己也会取消预约（p = 0.015）。患者对会诊的满意度良好（平均4.3/5.0，改良FAPI），与机构、会诊时长与会诊伙伴无关。疼痛强度高的患者满意度最低（p = 0.036）。只有42/100（38.2%）的患者接种了肺炎球菌疫苗，59/100（53.6%）的患者接种了流感疫苗。
电话会诊框架内的远程医疗护理非常适合特定患者。就患者满意度而言，将远程医疗会诊委托给RFA是可行的。在疫苗接种行为方面有改进的必要。
