Telehealth in Rheumatology: The 2021 Arab League of Rheumatology Best Practice Guidelines

Background Telehealth use is increasing and will undeniably continue to play a role beyond the COVID-19 era. Best practice guidelines (BPG) for telehealth add credibility, standardize approaches, facilitate reimbursement, and decrease liability. Objectives To develop BPG for the use of Telehealth In Rheumatology in the Arab region, to identify the top barriers and facilitators of telehealth in the Arab region, and to provide rheumatologists with a practical toolkit for the implementation of telehealth. Methods Guidelines were drafted by a core steering committee from the Arab League of Associations for Rheumatology (ArLAR) after performing a literature search. A multidisciplinary task force (TF), including 18 rheumatologists, 2 patients, and 2 regulators from 15 Arab countries, assessed the BPG using 3 rounds of anonymous online voting by modified Delphi process. The voting on barriers and facilitators was performed through one voting round. The toolkit was developed based on available literature and discussions during the Delphi rounds. Results Four General Principles and twelve Statements were formulated. All statements reached >80% consensus. A teleconsultation was specifically defined for the purpose of these guidelines. The concept of choice in telehealth was highlighted, emphasizing patient confidentiality, medical information security, rheumatologist’s clinical judgment, and local jurisdictional regulations. The top barrier for telehealth was the concern about the quality of care. The toolkit emphasized technical aspects of teleconsultation and proposed a triage system. Conclusions The ArLAR BPG provides rheumatologists with a series of strategies about the most reliable, productive, and rational approaches to apply telehealth. Strengths and limitations of this study ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by an unrestricted research grant from Pfizer Gulf FZ LLC, covering the fees of medical writing and Delphi panel platform. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Disclaimer This project was not intended as a medical research project, or to assist with the preparation of any representative statistics to be published. Consequently, no regulatory approvals have been obtained in connection with this project and the survey. Task Force members did not receive any fees for their participation in the project. All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Extra data regarding the details about all three Delphi rounds are available in the supplementary material.