APLAR recommendations on the practice of telemedicine in rheumatology

Abstract

Introduction The COVID‐19 pandemic led to rapid and widespread adoption of telemedicine in rheumatology care. The Asia Pacific League of Associations for Rheumatology (APLAR) working group was tasked with developing evidence‐based recommendations for rheumatology practice to guide maintenance of the highest possible standards of clinical care and to enable broad patient reach. Materials and methods A systematic review of English‐language articles related to telehealth in rheumatology was conducted on MEDLINE/PubMed, Web Of Science and Scopus. The strength of the evidence was graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach as well as the Oxford Levels of Evidence. The recommendations were developed using a modified Delphi technique to establish consensus. Results Three overarching principles and 13 recommendations were developed based on identified literature and consensus agreement. The overarching principles address telemedicine frameworks, decision‐making, and modality. Recommendations 1‐4 address patient suitability, triage, and when telemedicine should be offered to patients. Recommendations 5‐10 cover the procedure, including the means, data safety, fail‐safe mechanisms, and treat‐to‐target approach. Recommendations 11‐13 focus on training and education related to telerheumatology. Conclusion These recommendations provide guidance for the approach and use of telemedicine in rheumatology care to guide highest possible standards of clinical care and to enable equitable patient reach. However, since evidence in telemedicine care in rheumatology is limited and emerging, most recommendations will need further consideration when more data are available.

Use of telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak: The 6-month results of a randomized controlled trial

“…5,6 Various modes of delivery of TM, including synchronous (i.e., video and telephone) and non-synchronous (i.e., email and short message service), are available, with video consultation more advocated. 7 Despite being widely adopted during this pandemic, the evidence supporting the use of TM in rheumatology has been limited. According to a systematic review in 2017, there is no good evidence in supporting the use of TM for managing rheumatic diseases due to the high risk of bias of the published studies.…”

Virtual Care Use in Primary Care or Specialty Care Settings

“…The first guideline, published in 2022 by the Asia Pacific League of Associations for Rheumatology (APLAR), provided evidencebased recommendations for telemedicine in rheumatology. 14 The second guideline, published in 2022 by a committee from the Arab League of Associations for Rheumatology (ArLAR), 16 provided general principals and best practice guidelines for telehealth in rheumatology.…”

“…Overall, 5 evidence-based guidelines met the eligibility criteria and were included in this report. [14][15][16][17][18] Additional details regarding the characteristics of included publications are provided in Appendix 2.…”

“…The interventions considered within the APLAR guidelines 14 were for telemedicine in rheumatology practice, where telemedicine was defined as "the delivery of health care services, where distance is a critical factor, by all health care professionals using information and communication technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of health care providers, all in the interests of advancing the health of individuals and their communities" (p.248). 14 The ArLAR guidelines 16 considered best practice interventions for teleconsultation in rheumatology, where teleconsultation was defined as the "synchronous exchange of medical information between a patient and a rheumatologist via audio or audiovisual electronic communication, to improve the patient's health status" (p.381). 16 The ASCO recommendations 17…”

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“…This principle has been significantly improved over the past few years. We have successively published the Asia‐Pacific guidelines or consensus recommendation articles for osteoarthritis, rheumatoid arthritis, lupus erythematosus, spondyloarthritis, gout, and other diseases 1‐13 . During the coronavirus disease 2019 (COVID‐19) pandemic, we have also published many practical guidelines, especially for the Asia‐Pacific region 10‐13 .…”