The experts did address the risk of bias in these studies, which at first glance didn’t appear favorable. Only 30% of the studies had a low risk of bias, 23% had a medium risk and 47% had a high risk.
“If these studies were for a new medication, would you take this drug?” the experts asked. An audience member made the astute point that if the studies with a low risk of bias were large, randomized controlled trials, then yes, he would.
Dr. De Thurah said, “We can’t blind the intervention in [studies that examine remote vs. face-to-face care], so there will always be some selection bias. But there’s so much evidence pointing in the same direction here that yes, I’d take that drug too. … Results depend on the quality of the study. We know these interventions must be developed based on participatory design in close collaboration with all relevant stakeholders.”
Question 2: Does remote care contribute to inequity?
The overwhelming majority of the audience responded with yes, and the experts agreed.
Remote care may not be equally accessible to all patients due to differences in internet access and tech savvy. The language the patient speaks matters, too. One expert noted that more than 85% of health apps are developed in English. Thus, non-English speakers and others with difficulty communicating in English have problems using these tools.
Another important consideration is app development. Who the app developer is plays an important role in designing the product that will best serve users. Take Whitney Wolfe Herd, the founder of the dating app Bumble, for example. She left Tinder to create a dating app that was more female friendly. She is now the world’s youngest, self-made female billionaire.
The experts stressed the importance of including end users (patients) in the app development process. Simply put, if we want to create apps that a diverse array of patients can use, we need to include a diverse array of patients in the creation process. Involving stakeholders is one of the best ways to combat inequity.
Question 3: Does shared decision making between patient & health professionals work in remote care?
Two-thirds of the audience thought that shared decision making worked during remote care, and one-third felt it didn’t. The experts’ answer: The jury is still out.
A 2022 systematic review of the literature on shared decision making through telemedicine included only 12 studies, none of which focused on patients with rheumatic and musculoskeletal diseases. Further, none of these studies tested the effects of remote care on shared decision making. They were mostly qualitative.4
