Lesley E Jackson, Jinoos Yazdany, Justin M Leach, Kenneth G Saag, Kiara Aaron, Jeffrey R Curtis, Sarah Goglin, Mary Margaretten, David H Chae, Diana Paez, Gary Cutter, Maria I Danila
{"title":"风湿病学远程医疗满意度与现场就诊满意度:一项非劣效性随机对照试验。","authors":"Lesley E Jackson, Jinoos Yazdany, Justin M Leach, Kenneth G Saag, Kiara Aaron, Jeffrey R Curtis, Sarah Goglin, Mary Margaretten, David H Chae, Diana Paez, Gary Cutter, Maria I Danila","doi":"10.1016/j.ard.2025.03.003","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>We tested whether a rheumatology telemedicine visit was noninferior to an in-person visit for patient satisfaction and care effectiveness, including for subgroups of age, sex, race and ethnicity, income, and employment status.</p><p><strong>Methods: </strong>This multicenter noninferiority trial randomised patients to 1 in-person or telemedicine visit. The primary outcome was the proportion of high visit satisfaction (9 or 10 on a 0-10 scale). The primary analysis tested whether patient satisfaction with telemedicine was noninferior to in-person care (10% noninferiority margin). Secondary and exploratory outcomes included preference for next visit type, satisfaction in subgroups, and immunosuppressant toxicity monitoring. We performed modified intent-to-treat (mITT) and per-protocol analyses.</p><p><strong>Results: </strong>Among 651 randomised patients (in-person, n = 323; telemedicine n = 328), 500 (76.8%) had a visit defining the mITT population. Satisfaction with telemedicine was not noninferior to in-person; 77.0% telemedicine, 90.1% in-person, difference 13.1% (90% CI, 7.7%-18.5%). Per-protocol analysis results were consistent. More participants in the in-person group compared with those in telemedicine preferred the same visit type for their next visit vs a different visit type/no preference (55.6% in-person, 19.1% telemedicine, P < .0001, mITT analysis). Men were equally satisfied with both visit types (90.0%), while women were more likely to be satisfied with in-person visits (90.2% vs 74.7%). Toxicity monitoring rates were higher in in-person vs telemedicine (eg, hepatic function: 92.1% vs 66.3%, P = .0001, per-protocol analysis).</p><p><strong>Conclusions: </strong>Among a large group of diverse patients, satisfaction with telemedicine was not noninferior to in-person rheumatology visits. More participants preferred in-person visits in the mITT and per-protocol analyses. Appropriate toxicity monitoring was lower in telemedicine vs in-person groups.</p>","PeriodicalId":8087,"journal":{"name":"Annals of the Rheumatic Diseases","volume":" ","pages":""},"PeriodicalIF":20.3000,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Satisfaction with telemedicine versus in-person visits in rheumatology: a noninferiority randomised controlled trial.\",\"authors\":\"Lesley E Jackson, Jinoos Yazdany, Justin M Leach, Kenneth G Saag, Kiara Aaron, Jeffrey R Curtis, Sarah Goglin, Mary Margaretten, David H Chae, Diana Paez, Gary Cutter, Maria I Danila\",\"doi\":\"10.1016/j.ard.2025.03.003\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We tested whether a rheumatology telemedicine visit was noninferior to an in-person visit for patient satisfaction and care effectiveness, including for subgroups of age, sex, race and ethnicity, income, and employment status.</p><p><strong>Methods: </strong>This multicenter noninferiority trial randomised patients to 1 in-person or telemedicine visit. The primary outcome was the proportion of high visit satisfaction (9 or 10 on a 0-10 scale). The primary analysis tested whether patient satisfaction with telemedicine was noninferior to in-person care (10% noninferiority margin). Secondary and exploratory outcomes included preference for next visit type, satisfaction in subgroups, and immunosuppressant toxicity monitoring. We performed modified intent-to-treat (mITT) and per-protocol analyses.</p><p><strong>Results: </strong>Among 651 randomised patients (in-person, n = 323; telemedicine n = 328), 500 (76.8%) had a visit defining the mITT population. Satisfaction with telemedicine was not noninferior to in-person; 77.0% telemedicine, 90.1% in-person, difference 13.1% (90% CI, 7.7%-18.5%). Per-protocol analysis results were consistent. More participants in the in-person group compared with those in telemedicine preferred the same visit type for their next visit vs a different visit type/no preference (55.6% in-person, 19.1% telemedicine, P < .0001, mITT analysis). Men were equally satisfied with both visit types (90.0%), while women were more likely to be satisfied with in-person visits (90.2% vs 74.7%). Toxicity monitoring rates were higher in in-person vs telemedicine (eg, hepatic function: 92.1% vs 66.3%, P = .0001, per-protocol analysis).</p><p><strong>Conclusions: </strong>Among a large group of diverse patients, satisfaction with telemedicine was not noninferior to in-person rheumatology visits. More participants preferred in-person visits in the mITT and per-protocol analyses. 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Satisfaction with telemedicine versus in-person visits in rheumatology: a noninferiority randomised controlled trial.
Objectives: We tested whether a rheumatology telemedicine visit was noninferior to an in-person visit for patient satisfaction and care effectiveness, including for subgroups of age, sex, race and ethnicity, income, and employment status.
Methods: This multicenter noninferiority trial randomised patients to 1 in-person or telemedicine visit. The primary outcome was the proportion of high visit satisfaction (9 or 10 on a 0-10 scale). The primary analysis tested whether patient satisfaction with telemedicine was noninferior to in-person care (10% noninferiority margin). Secondary and exploratory outcomes included preference for next visit type, satisfaction in subgroups, and immunosuppressant toxicity monitoring. We performed modified intent-to-treat (mITT) and per-protocol analyses.
Results: Among 651 randomised patients (in-person, n = 323; telemedicine n = 328), 500 (76.8%) had a visit defining the mITT population. Satisfaction with telemedicine was not noninferior to in-person; 77.0% telemedicine, 90.1% in-person, difference 13.1% (90% CI, 7.7%-18.5%). Per-protocol analysis results were consistent. More participants in the in-person group compared with those in telemedicine preferred the same visit type for their next visit vs a different visit type/no preference (55.6% in-person, 19.1% telemedicine, P < .0001, mITT analysis). Men were equally satisfied with both visit types (90.0%), while women were more likely to be satisfied with in-person visits (90.2% vs 74.7%). Toxicity monitoring rates were higher in in-person vs telemedicine (eg, hepatic function: 92.1% vs 66.3%, P = .0001, per-protocol analysis).
Conclusions: Among a large group of diverse patients, satisfaction with telemedicine was not noninferior to in-person rheumatology visits. More participants preferred in-person visits in the mITT and per-protocol analyses. Appropriate toxicity monitoring was lower in telemedicine vs in-person groups.
期刊介绍:
Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.