Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association

Claire E H Barber; Deborah M Levy; Vandana Ahluwalia; Arielle Mendel; Regina Taylor-Gjevre; Tommy Gerschman; Sahil Koppikar; Konstantin Jilkine; Elizabeth Stringer; Cheryl Barnabe; Sibel Zehra Aydin; Nadia Luca; Roberta Berard; Keith Tam; Jennifer Burt; Jocelyne C Murdoch; Graeme Zinck; Therese Lane; Jennifer Heeley; Megan Mannerow; Renee Mills; Linda Wilhelm; Nicole M S Hartfeld; Brent Ohata

doi:10.3899/jrheum.211017

Best Practices for Virtual Care: A Consensus Statement From the Canadian Rheumatology Association

J Rheumatol. 2022 Apr;49(4):408-418. doi: 10.3899/jrheum.211017. Epub 2022 Feb 1.

Authors

Claire E H Barber¹, Deborah M Levy², Vandana Ahluwalia³, Arielle Mendel⁴, Regina Taylor-Gjevre⁵, Tommy Gerschman⁶, Sahil Koppikar⁷, Konstantin Jilkine⁸, Elizabeth Stringer⁹, Cheryl Barnabe¹⁰, Sibel Zehra Aydin¹¹, Nadia Luca¹², Roberta Berard¹³, Keith Tam¹⁴, Jennifer Burt¹⁵, Jocelyne C Murdoch¹⁶, Graeme Zinck¹⁷, Therese Lane¹⁸, Jennifer Heeley¹⁷, Megan Mannerow¹⁷, Renee Mills¹⁷, Linda Wilhelm¹⁸, Nicole M S Hartfeld¹⁴, Brent Ohata¹⁹

Affiliations

¹ C.E.H. Barber, MD, PhD, FRCPC, Associate Professor, C. Barnabe, MD, MSc, FRCPC, Professor, Department of Medicine, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Arthritis Research Canada, Vancouver, British Columbia, and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta; cehbarbe@ucalgary.ca.
² D.M. Levy, MD, MS, FRCPC, Associate Professor, Hospital for Sick Children, Toronto, and Department of Pediatrics, Division of Pediatric Rheumatology, University of Toronto, Toronto, Ontario.
³ V. Ahluwalia, MD, FRCPC, William Osler Health System, Department of Medicine, Division of Rheumatology, Brampton, Ontario.
⁴ A. Mendel, MD, FRCPC, MSc, Assistant Professor, Department of Medicine, Division of Rheumatology, McGill University Health Centre, and Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec.
⁵ R. Taylor-Gjevre, MD, MSc, FRCPC, DRCPC, Professor of Medicine, Department of Medicine, Division of Rheumatology, University of Saskatchewan, Saskatoon, Saskatchewan.
⁶ T. Gerschman, MD, MSc, Department of Pediatrics, Division of Pediatric Rheumatology, University of British Columbia, Vancouver, British Columbia.
⁷ S. Koppikar, MD, FRCPC, Women's College Hospital, Toronto, Timmins and District Hospital, Timmins, and Department of Medicine, Division of Rheumatology, University of Toronto, Toronto, Ontario.
⁸ K. Jilkine, MD, FRCPC, Assistant Professor of Medicine, Department of Medicine, Division of Rheumatology, University of Manitoba, Winnipeg, Manitoba.
⁹ E. Stringer, MD, MSc, FRCPC, Associate Professor of Pediatrics, Department of Pediatrics, Division of Pediatric Rheumatology, Dalhousie University, Halifax, Nova Scotia.
¹⁰ C.E.H. Barber, MD, PhD, FRCPC, Associate Professor, C. Barnabe, MD, MSc, FRCPC, Professor, Department of Medicine, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Arthritis Research Canada, Vancouver, British Columbia, and McCaig Institute for Bone and Joint Health, University of Calgary, Alberta.
¹¹ S.Z. Aydin, MD, Associate Professor, Department of Medicine, Division of Rheumatology, University of Ottawa, Ottawa, The Ottawa Hospital Research Institute, Ottawa, Ontario.
¹² N. Luca, MD, MSc, FRCPC, Clinical Associate Professor, Department of Pediatrics, Section of Rheumatology, University of Calgary, and Alberta Children's Hospital Research Institute, Calgary, Alberta.
¹³ R. Berard, MD, MSc, FRCPC, Associate Professor of Pediatrics, Department of Pediatrics, Division of Rheumatology, Western University, London, Ontario.
¹⁴ K. Tam, MD, N.M.S. Hartfeld, MSc, MC, CCC, Department of Medicine, University of Calgary, Calgary, Alberta.
¹⁵ J. Burt, BScPT, ACPAC ERP, Division of Rheumatology, Eastern Health, Eastern Health, St. John's, Newfoundland.
¹⁶ J.C. Murdoch, BScOT, ACPAC ERP, Arthritis Society, Toronto, Ontario.
¹⁷ G. Zinck, Patient Partner, J. Heeley, BSW, Parent Partner, M. Mannerow, Parent Partner, R. Mills, Patient Partner, Cassie + Friends, Vancouver, British Columbia.
¹⁸ T. Lane, BScN, Patient Partner, L. Wilhelm, Patient Partner, Canadian Arthritis Patient Alliance.
¹⁹ B. Ohata, MD, FRCPC, Clinical Assistant Professor, Department of Medicine, Division of Rheumatology, University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 35105707
DOI: 10.3899/jrheum.211017

Abstract

Objective: To develop best practice statements for the provision of virtual care in adult and pediatric rheumatology for the Canadian Rheumatology Association's (CRA) Telehealth Working Group (TWG).

Methods: Four members of the TWG representing adult, pediatric, university-based, and community rheumatology practices defined the scope of the project. A rapid literature review of existing systematic reviews, policy documents, and published literature and abstracts on the topic was conducted between April and May 2021. The review informed a candidate set of 7 statements and a supporting document. The statements were submitted to a 3-round (R) modified Delphi process with 22 panelists recruited through the CRA and patient advocacy organizations. Panelists rated the importance and feasibility of the statements on a Likert scale of 1-9. Statements with final median ratings between 7-9 with no disagreement were retained in the final set.

Results: Twenty-one (95%) panelists participated in R1, 15 (71%) in R2, and 18 (82%) in R3. All but 1 statement met inclusion criteria during R1. Revisions were made to 5/7 statements following R2 and an additional statement was added. All statements met inclusion criteria following R3. The statements addressed the following themes in the provision of virtual care: adherence to existing standards and regulations, appropriateness, consent, physical examination, patient-reported outcomes, use in addition to in-person visits, and complex comanagement of disease.

Conclusion: The best practice statements represent a starting point for advancing virtual care in rheumatology. Future educational efforts to help implement these best practices and research to address identified knowledge gaps are planned.

Keywords: rheumatology; virtual care.

Publication types

Consensus Development Conference

MeSH terms

Canada
Consensus
Delphi Technique
Humans
Rheumatology*