Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Clinic 1J, Durham, NC 27710, USA; Division of Rheumatology, Department of Medicine, Durham Veterans Affairs Medical Center, Durham, NC 27710, USA.
Rheumatology Fellowship Training Program, Division of Rheumatology and Immunology, Department of Medicine, Duke University School of Medicine, 40 Duke Medicine Circle, Clinic 1J, Durham, NC 27710, USA.
Rheum Dis Clin North Am. 2025 Feb;51(1):93-110. doi: 10.1016/j.rdc.2024.08.006. Epub 2024 Oct 8.
During the COVID-19 pandemic, telemedicine was rapidly deployed to meet the clinical needs of patients with rheumatic diseases worldwide. Rheumatologists were forced to care for patients with all rheumatic diseases, regardless of disease activity, and limited evidence was available to guide provider decision-making regarding telemedicine appropriateness for outpatient rheumatology encounters. As the COVID-19 pandemic progressed, the ongoing provision of rheumatology telemedicine care in the U.S. was made possible by (1) emergency telemedicine waivers that permitted rheumatologists to legally practice across state lines; and (2) increased telemedicine reimbursement rates from the Centers for Medicare and Medicaid Services. Telemedicine research in rheumatology expanded exponentially, and patterns began to emerge regarding multilevel factors associated with telemedicine appropriateness for patients with rheumatic diseases. Rheumatology practice patterns also evolved to address the unique challenges of providing virtual care, such as the use of patient-reported outcomes and physical examination modifications to remotely assess disease activity. Moving beyond the COVID-19 pandemic, telemedicine has the potential to increase access to rheumatology care by utilizing finite rheumatology clinical resources in more efficient and innovative ways. However, barriers to more fully integrating telemedicine into routine rheumatology care remain, including training the rheumatology workforce, suboptimal reimbursement rates for telemedicine services, variability in state telemedicine laws, and the need to build telemedicine support networks of interdisciplinary and interprofessional care team members. As the use of telemedicine in rheumatology continues to evolve, it is vital for rheumatologists to maintain a patient-centered focus in the continued delivery of safe, effective, and equitable rheumatology care.
在 COVID-19 大流行期间，远程医疗迅速投入使用，以满足全球风湿病患者的临床需求。风湿病学家被迫照顾所有风湿病患者，无论疾病活动程度如何，而且几乎没有证据可以指导提供者就远程医疗是否适合门诊风湿病就诊做出决策。随着 COVID-19 大流行的进展，美国继续提供风湿病远程医疗护理，这得益于 (1) 紧急远程医疗豁免，允许风湿病学家在州际范围内合法行医；和 (2) 医疗保险和医疗补助服务中心增加了远程医疗报销率。风湿病学的远程医疗研究呈指数级增长，并且开始出现与风湿病患者远程医疗适宜性相关的多层次因素的模式。风湿病学的实践模式也在不断发展，以解决提供虚拟护理的独特挑战，例如使用患者报告的结果和体格检查修改来远程评估疾病活动。远程医疗超越了 COVID-19 大流行，有可能通过以更有效和创新的方式利用有限的风湿病临床资源来增加获得风湿病护理的机会。然而，仍然存在一些障碍，无法将远程医疗更充分地纳入常规风湿病护理，包括培训风湿病工作队伍、远程医疗服务的报销率不理想、州远程医疗法律的差异，以及需要建立跨学科和跨专业护理团队成员的远程医疗支持网络。随着远程医疗在风湿病学中的应用不断发展，风湿病学家在继续提供安全、有效和公平的风湿病护理时，必须保持以患者为中心的重点。
