Systematic Review of Outcomes and Patient Experience With Virtual Care in Rheumatoid Arthritis.

Abstract

To conduct a systematic review on patient outcomes of virtual care compared to conventional care in rheumatoid arthritis (RA), including disease activity and patient experience. A systematic search of Medline, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials was performed from database inception to March 19, 2020. Observational and randomized controlled trials (RCTs) describing the use of RA virtual care supplanting conventional visits and reporting on disease activity and/or patient experience were included. A narrative synthesis of results was conducted, as a meta-analysis was not possible due to heterogeneity of study designs and outcome reporting. A total of 352 studies were identified, and 6 were selected for final inclusion: 3 RCTs and 3 observational studies. Disease activity and patient experience were comparable between virtual and conventional care models. In addition, 1 RCT found no difference in observed outcomes between virtual care delivered by a rheumatologist and by a rheumatology nurse. Virtual care was found to have additional benefits for improved treatment adherence, maintenance of functional status, and quality of life. The overall risk of bias was low in 2 of 3 RCTs, but high in the observational studies. Study quality was limited by incomplete data reporting, lack of sample size justification, and sufficient timeframe to assess objectives. Limited evidence exists that virtual RA care is an acceptable alternative to conventional care, maintaining comparable patient outcomes and experience of care. Additional research into effective implementation strategies and long-term health system and patient outcomes of virtual care are needed.