Comparing Rheumatology Consultation Patterns Across Telehealth Platforms and Face-to-Face Clinic in the Military...

Area of Science:

• Rheumatology
• Telemedicine
• Military Health System

Background:

• The Military Health System (MHS) utilizes various platforms for rheumatology consultations, including in-person and telehealth options.
• Understanding consultation patterns and outcomes across these platforms is crucial for optimizing care delivery.

Purpose of the Study:

• To compare rheumatology consultation patterns and outcomes across face-to-face, synchronous telehealth, and two asynchronous telehealth platforms within the MHS.
• To evaluate the effectiveness of different telerheumatology modalities in managing diverse rheumatic conditions.

Main Methods:

• A retrospective review compared face-to-face consultations (2019) with three virtual systems: asynchronous email (2006-2018), asynchronous web-based (2014-2018), and synchronous telehealth (2020-2021).
• Consultations were analyzed for diagnoses, medical evacuations (OCONUS), and required face-to-face follow-up.

Main Results:

• Leading diagnoses across all platforms included inflammatory arthritis, noninflammatory arthritis, and other rheumatic diseases.
• Consultation modality impacted case types: synchronous and email-based models saw more inflammatory arthritis, while web-based models handled more 'other diagnoses'.
• Synchronous models managed more crystalline arthritis, vasculitis, and fibromyalgia cases, with varying rates of medical evacuation or need for follow-up.

Conclusions:

• Consultation modality influences the types of rheumatology cases managed.
• Both synchronous and asynchronous telerheumatology successfully answered consult questions without requiring face-to-face evaluation in 79.9-85.0% of cases.
• Teleconsultation is a viable method for expanding access to high-quality rheumatology care within the MHS.