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Zafar SN, Hazlewood G, Dhiman K, Charlton A, Then KL, Dempsey E, Lester R, Hoens AM, Lacaille D, Barnabe C, Rankin J, Mosher D, Barber CEH. "How are you?" Perspectives From Patients and Health Care Providers of Text Messaging to Support Rheumatoid Arthritis Care: A Thematic Analysis. ACR Open Rheumatol 2024; 6:276-286. [PMID: 38376004 PMCID: PMC11089442 DOI: 10.1002/acr2.11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/24/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) may need to access rheumatology care between scheduled visits. WelTel is a virtual care platform that supports secure two-way text-messaging between patients and their health care team. The objective of the present study was to explore perspectives and experiences of health care providers (HCPs) and patients related to the use of WelTel as an adjunct to routine care. METHODS Seventy patients with RA were enrolled in a six-month WelTel pilot project launched in September 2021. Patients received monthly "How are you?" text message check-ins and could message their health care team during clinic hours to request health advice. The current project is a qualitative study of the WelTel pilot. A subgroup of pilot participants was purposively sampled and invited to participate in interviews. A thematic analysis of transcripts was conducted using a deductive approach leveraging quality of care domains. RESULTS Thirteen patients (62% female, mean age 62 years, 10 White) completed interviews. Patients' views suggested that text messaging with the rheumatology team supported high-quality care across multiple quality domains including patient-centeredness, timeliness, efficiency, safety, effectiveness, equity, and appropriateness. Seven HCPs (57.1% female, one pharmacist and six rheumatologists) completed interviews. HCPs' perspectives varied based on their experience with the WelTel platform. Additional themes reported by HCPs included perceived increased workload and burnout. CONCLUSIONS Patients with RA perceived text-based messaging as supporting high-quality care. The impact of increased communications on HCP burnout and workload requires consideration, and future studies should evaluate the effect of texting on patient outcomes.
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Affiliation(s)
- Saania N. Zafar
- University of Calgary, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - Glen Hazlewood
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | | | | | - Karen L. Then
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Erika Dempsey
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Richard Lester
- University of British Columbia and WelTel IncVancouverBritish ColumbiaCanada
| | - Alison M. Hoens
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research Canada and University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Cheryl Barnabe
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - James Rankin
- University of Calgary, Calgary, Alberta, Canada, and Thompson Rivers UniversityKamloopsBritish ColumbiaCanada
| | - Dianne Mosher
- Alberta Health Services and University of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- University of Calgary and Alberta Health Services, Calgary, Alberta, Canada, and Arthritis Research CanadaVancouverBritish ColumbiaCanada
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Goglin S, Kolfenbach J. The Impact of COVID-19 on Education and Training in Rheumatology: A Narrative Review. Arthritis Care Res (Hoboken) 2024; 76:32-39. [PMID: 37849427 DOI: 10.1002/acr.25258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023]
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Hitchon CA, ONeil L, Peschken CA, Robinson DB, Fowler-Woods A, El-Gabalawy HS. Disparities in rheumatoid arthritis outcomes for North American Indigenous populations. Int J Circumpolar Health 2023; 82:2166447. [PMID: 36642913 PMCID: PMC9848324 DOI: 10.1080/22423982.2023.2166447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.
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Affiliation(s)
- Carol A Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,CONTACT Carol A Hitchon Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, CAN, RR149 800 Sherbrook Street, Winnipeg, ManitobaR3A 1M4Canada
| | - Liam ONeil
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christine A Peschken
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada,Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David B Robinson
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amanda Fowler-Woods
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Hani S El-Gabalawy
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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4
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Improving access to care for rheumatology services in Canada. Clin Rheumatol 2023; 42:1205-1211. [PMID: 36746833 PMCID: PMC9901822 DOI: 10.1007/s10067-023-06532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/13/2023] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
Rheumatic diseases are becoming increasingly prevalent in Canada, and its associated strain on the healthcare system is expected to increase over the next decades. Furthermore, there is an increasing body of evidence to suggest that access to rheumatology care is currently not meeting established quality of care benchmarks. To frame issues affecting access to care for rheumatology services in Canada, a proposed chronological framework from a rheumatology patient's perspective is proposed. Illustrating principles from a health policy lens including drawing from the stages heuristic framework and multiple streams theory, issues surrounding access to rheumatology assessment, to rheumatological investigations and lastly to appropriate treatment are explored. In particular, the current supply and demand mismatch within the rheumatology workforce presents challenges for patients in accessing rheumatic diseases providers. Potential policy solutions including increasing the pool of rheumatic diseases care providers, enhancing the clinical capacity with extended role providers and increasing uptake of virtual care are discussed. To ameliorate access to rheumatology investigations, the concept of provider education surrounding the appropriateness of investigations and merit-based funding are explored. Lastly, access to rheumatological treatment is framed using biologic therapies as an example, highlighting the policy challenges in biosimilar uptake and associated ethical and political considerations. By using a health policy lens to explore deficiencies within Canada's current system, the overarching goal of this analysis is to set the stage for reasoned and timely solutions in the future.
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Moecke DP, Holyk T, Beckett M, Chopra S, Petlitsyna P, Girt M, Kirkham A, Kamurasi I, Turner J, Sneddon D, Friesen M, McDonald I, Denson-Camp N, Crosbie S, Camp PG. Scoping review of telehealth use by Indigenous populations from Australia, Canada, New Zealand, and the United States. J Telemed Telecare 2023:1357633X231158835. [PMID: 36911983 DOI: 10.1177/1357633x231158835] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
INTRODUCTION Telehealth has the potential to address health disparities experienced by Indigenous people, especially in remote areas. This scoping review aims to map and characterize the existing evidence on telehealth use by Indigenous people and explore the key concepts for effective use, cultural safety, and building therapeutic relationships. METHODS A search for published and gray literature, written in English, and published between 2000 and 2022 was completed in 17 electronic databases. Two reviewers independently screened retrieved records for eligibility. For included articles, data were extracted, categorized, and analyzed. Synthesis of findings was performed narratively. RESULTS A total of 321 studies were included. The most popular type of telehealth used was mHealth (44%), and the most common health focuses of the telehealth interventions were mental health (26%) and diabetes/diabetic retinopathy (13%). Frequently described barriers to effective telehealth use included concerns about privacy/confidentiality and limited internet availability; meanwhile, telehealth-usage facilitators included cultural relevance and community engagement. Although working in collaboration with Indigenous communities was the most frequently reported way to achieve cultural safety, 40% of the studies did not report Indigenous involvement. Finally, difficulty to establish trusting therapeutic relationships was a major concern raised about telehealth, and evidence suggests that having the first visit-in-person is a potential way to address this issue. CONCLUSION This comprehensive review identified critical factors to guide the development of culturally-informed telehealth services to meet the needs of Indigenous people and to achieve equitable access and positive health outcomes.
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Affiliation(s)
- Débora Petry Moecke
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Travis Holyk
- Carrier Sekani Family Services, Prince George, Canada
| | - Madelaine Beckett
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Sunaina Chopra
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Mirha Girt
- 1974Faculty of Medicine, University of Queensland, Brisbane, Australia
| | | | - Ivan Kamurasi
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Justin Turner
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | - Donovan Sneddon
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
| | | | - Ian McDonald
- University of British Columbia (UBC), Vancouver, Canada
| | | | | | - Pat G Camp
- University of British Columbia (UBC), Vancouver, Canada.,Faculty of Medicine, 8166University of British Columbia, Vancouver, Canada
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Guaracha-Basáñez GA, Contreras-Yáñez I, Estrada-González VA, Estrada-González VA, Valverde-Hernández SS, Hernández-Molina G, Pascual-Ramos V. Comparison of Teleconsultations and In-Person Consultations from Outpatients with Rheumatoid Arthritis, During the COVID-19 Pandemic: An Internal Audit of Medical Notes. Telemed J E Health 2022; 28:1835-1842. [PMID: 35506921 DOI: 10.1089/tmj.2022.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The objectives of this study were to compare the quality-of-care and compliance with medical record regulations between in-person consultations (QIP and CIP) and telephone consultations (QTP and CTP), from rheumatoid arthritis (RA) outpatients, during the COVID-19 pandemic, and to explore the impact of the consultation modality on the treatment. Methods: Data from 324 medical notes corresponding to rheumatic consultations between July and December 2020 were abstracted. Notes were selected considering a stratified (in-person and telephone consultations) random sampling strategy. QIP, CIP, QTP, and CTP were scored based on prespecified criteria as percentages, where higher numbers translated into better standards. Logistic regression analysis investigated the association between the consultation modality and the treatment recommendation (dependent variable). Results: There were 208 (64.2%) medical notes related to in-person consultations and 114 (35.2%) to telephone consultations. Overall, medical notes corresponded to middle-aged women with long-standing disease. QIP was superior to QTP (median, interquartile range): 60% (60-75%) versus 50% (25-60%), p ≤ 0.001, and differences were related to disease activity and prognosis documentation (81.3% vs. 34.5% and 55.8% vs. 33.6%, respectively, p ≤ 0.001) and the prolonged prescription of glucocorticoids with a documented management plan (58.5% vs. 30.4%, p = 0.045). Meanwhile, CIP and CTP were similar. Telephone consultation was a significant risk factor for no changes in the treatment recommendation (odds ratio: 2.113, 95% confidence interval: 1.284-3.479, p = 0.003), and results were consistent in the 142 medical notes with documented absence of disease activity. Conclusions: In the clinical context of RA, the quality-of-care provided by telephone consultations is below the standard of care and impacts the treatment.
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Affiliation(s)
- Guillermo A Guaracha-Basáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Vivian A Estrada-González
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Salvador S Valverde-Hernández
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Gabriela Hernández-Molina
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, National Institute of Medical Sciences and Nutrition "Salvador-Zubirán", Mexico City, Mexico
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Smith ID, Coles TM, Howe C, Overton R, Economou‐Zavlanos N, Solomon MJ, Zhao R, Adagarla B, Doss J, Henao R, Clowse MEB, Leverenz DL. Telehealth Made
EASY
: Understanding Provider Perceptions of Telehealth Appropriateness in Outpatient Rheumatology Encounters. ACR Open Rheumatol 2022; 4:845-852. [PMID: 35855564 PMCID: PMC9555194 DOI: 10.1002/acr2.11470] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/22/2022] Open
Abstract
Objective The purpose of this study was to evaluate a novel scoring system, the Encounter Appropriateness Score for You (EASY), to assess provider perceptions of telehealth appropriateness in rheumatology encounters. Methods The EASY scoring system prompts providers to rate their own encounters as follows: in‐person or telehealth acceptable, EASY = 1; in‐person preferred, EASY = 2; or telehealth preferred, EASY = 3. Assessment of the EASY scoring system occurred at a single academic institution from January 1, 2021, to August 31, 2021. Data were collected in three rounds: 1) initial survey (31 providers) assessing EASY responsiveness to five hypothetical scenarios, 2) follow‐up survey (34 providers) exploring EASY responsiveness to 11 scenario modifications, and 3) assessment of EASYs documented in clinic care. Results The initial and follow‐up surveys demonstrated responsiveness of EASYs to different clinical and nonclinical factors. For instance, less than 20% of providers accepted telehealth when starting a biologic for active rheumatoid arthritis, although more than 35% accepted telehealth in the same scenario if the patient lived far away or was well known to the provider. Regarding EASY documentation, 27 providers provided EASYs for 12,381 encounters. According to these scores, telehealth was acceptable or preferred for 29.7% of all encounters, including 21.4% of in‐person encounters. Conversely, 24.4% of telehealth encounters were scored as in‐person preferred. Conclusion EASY is simple, understandable, and responsive to changes in the clinical scenario. We have successfully accumulated 12,381 EASYs that can be studied in future work to better understand telehealth utility and optimize telehealth triage.
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Affiliation(s)
- Isaac D. Smith
- Department of Medicine, Duke University Hospital Duke University Hospital and Duke University School of Medicine Durham North Carolina USA
- Department of Medicine, Division of Rheumatology and Immunology Duke University School of Medicine Durham North Carolina USA
| | - Theresa M. Coles
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
| | - Catherine Howe
- Department of Medicine, Duke University Hospital Duke University Hospital and Duke University School of Medicine Durham North Carolina USA
| | - Robert Overton
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
| | - Nicoleta Economou‐Zavlanos
- AI Health Duke University School of Medicine Durham North Carolina USA
- Office of Academic Solutions and Information Systems Duke Health Technology Solutions, Duke Health Durham North Carolina USA
| | - Mary J. Solomon
- AI Health Duke University School of Medicine Durham North Carolina USA
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
| | - Rong Zhao
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
| | - Bhargav Adagarla
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
| | - Jayanth Doss
- Department of Medicine, Division of Rheumatology and Immunology Duke University School of Medicine Durham North Carolina USA
| | - Ricardo Henao
- Duke Clinical Research Institute Duke University School of Medicine Durham North Carolina USA
- Department of Biostatistics and Bioinformatics Duke University School of Medicine Durham North Carolina USA
| | - Megan E. B. Clowse
- Department of Medicine, Division of Rheumatology and Immunology Duke University School of Medicine Durham North Carolina USA
| | - David L. Leverenz
- Department of Medicine, Division of Rheumatology and Immunology Duke University School of Medicine Durham North Carolina USA
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9
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Pego-Reigosa JM, Peña-Gil C, Rodríguez-Lorenzo D, Altabás-González I, Pérez-Gómez N, Guzmán-Castro JH, Varela-Gestoso R, Díaz-Lambarri R, González-Carreró-López A, Míguez-Senra O, Bóveda-Fontán J, Charle-Crespo Á, Caramés-Casal FJ, Barbazán-Álvarez C, Hernández-Rodríguez Í, Maceiras-Pan F, Rodríguez-López M, Melero-González R, Rodríguez-Fernández JB. Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology. BMC Health Serv Res 2022; 22:60. [PMID: 35022061 PMCID: PMC8754366 DOI: 10.1186/s12913-021-07455-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/22/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.
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Affiliation(s)
- José María Pego-Reigosa
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Carlos Peña-Gil
- Cardiology Department, Santiago de Compostela Health Area, Santiago de Compostela, Spain
- Service of Research, Education, and Innovation, Galician Health Service, Santiago de Compostela, Spain
| | | | - Irene Altabás-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Naír Pérez-Gómez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - John Henry Guzmán-Castro
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | | | | | | | | | | | | | | | - Ceferino Barbazán-Álvarez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Íñigo Hernández-Rodríguez
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Francisco Maceiras-Pan
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Marina Rodríguez-López
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
| | - Rafael Melero-González
- Rheumatology Department, University Hospital of Vigo, Vigo Health Area, Alto do Meixoeiro s/n, 36200 Vigo, Spain
- IRIDIS (Investigation in Rheumatology and Immune-Mediated Diseases) Group, Galicia Sur Health Research Institute, Alto do Meixoeiro s/n, 36200 Vigo, Spain
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10
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Au Eong JTW, Lateef A, Liang S, Lim SHH, Tay SH, Mak A, Cho J. Impact of Teleconsultation on Subsequent Disease Activity and Flares in Patients with Systemic Lupus Erythematosus. Rheumatology (Oxford) 2021; 61:1911-1918. [PMID: 34554232 PMCID: PMC8500016 DOI: 10.1093/rheumatology/keab694] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Despite the widespread adoption of teleconsultations amid the COVID-19 pandemic, their safety in SLE patients has not been evaluated. Here, we examined subsequent disease activity and flares among SLE patients who received teleconsultation vs in-person consultation. To discern differences in physicians’ prescription behaviour during both forms of consultations, we compared corticosteroid dose adjustments. Methods We studied adult SLE patients who were seen between 1 February 2020 and 1 February 2021. At each patient-visit, rheumatologists utilized phone/video teleconsultation or physical consultation at their discretion. Disease activity was assessed with SLE Disease Activity Index 2000 (SLEDAI-2K) and flares were defined by the SELENA-SLEDAI Flare Index (SFI). We derived a propensity score for patients who were chosen for physical consultation. Multivariable generalized estimation equations were used to analyse SLEDAI-2k and flare at the next visit, adjusted for the propensity score. Results A total of 435 visits were recorded, of which 343 (78.9%) were physical visits and 92 (21.1%) were teleconsultations. The modality of consultation did not predict flare [OR for physical consultation (95% CI) 0.42 (0.04, 5.04), P =0.49] or SLEDAI-2k at the next visit [estimate of coefficient for physical consultation (95% CI) −0.19 (−0.80, 0.43), P =0.55]. Adjustments of prednisolone dosages were comparable between the two forms of visits [OR for physical consultation (95% CI) 1.34 (0.77, 2.34), P =0.30]. Conclusion SLE disease activity and flares at the subsequent visit were similar between teleconsultations and physical consultations. Medication prescription behaviour, determined using adjustment in corticosteroid dosages, was not different between the two forms of visits.
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Affiliation(s)
| | - Aisha Lateef
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE.,Division of Rheumatology, University Medicine Cluster, National University Hospital, SINGAPORE.,Department of Medicine, Woodlands Health Campus, SINGAPORE
| | - Shen Liang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE
| | - Sandy H H Lim
- Division of Rheumatology, University Medicine Cluster, National University Hospital, SINGAPORE
| | - Sen Hee Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE.,Division of Rheumatology, University Medicine Cluster, National University Hospital, SINGAPORE
| | - Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE.,Division of Rheumatology, University Medicine Cluster, National University Hospital, SINGAPORE
| | - Jiacai Cho
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, SINGAPORE.,Division of Rheumatology, University Medicine Cluster, National University Hospital, SINGAPORE
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11
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Tang W, Khalili L, Askanase A. Telerheumatology: A Narrative Review. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2021; 2:139-145. [PMID: 36465071 PMCID: PMC9524794 DOI: 10.2478/rir-2021-0020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 04/27/2023]
Abstract
Telemedicine (TM), the delivery of health care using telecommunication technologies, has been in use in rheumatology practice for over two decades to maximize access and optimize care. As a direct consequence of the Coronavirus disease 2019 (COVID-19) pandemic in March 2020, rheumatology practice shifted from traditional in-person encounters to TM to ensure the safety of both healthcare professionals and patients. However, there is limited literature on the acceptance, feasibility, and effectiveness of TM in the management of rheumatic diseases. Additionally, there is limited guidance on the implementation of telerheumatology (TR) for both patient care and clinical trials. Here we reviewed the most recent publications related to the application of TR, in the management of Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE), assessed the perceptions of patients and physicians on TM in rheumatology, and identified several key barriers to TR.
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Affiliation(s)
- Wei Tang
- Department of Medicine, Division of Rheumatology, Columbia University Irving Medical Center, New York, NY10032, USA
| | - Leila Khalili
- Department of Medicine, Division of Rheumatology, Columbia University Irving Medical Center, New York, NY10032, USA
| | - Anca Askanase
- Department of Medicine, Division of Rheumatology, Columbia University Irving Medical Center, New York, NY10032, USA
- E-mail:
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Kernder A, Morf H, Klemm P, Vossen D, Haase I, Mucke J, Meyer M, Kleyer A, Sewerin P, Bendzuck G, Eis S, Knitza J, Krusche M. Digital rheumatology in the era of COVID-19: results of a national patient and physician survey. RMD Open 2021; 7:rmdopen-2020-001548. [PMID: 33622673 PMCID: PMC7907631 DOI: 10.1136/rmdopen-2020-001548] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To analyse the impact of the COVID-19 pandemic on rheumatic patients' and rheumatologists' usage, preferences and perception of digital health applications (DHAs). METHODS A web-based national survey was developed by the Working Group Young Rheumatology of the German Society for Rheumatology and the German League against Rheumatism. The prospective survey was distributed via social media (Twitter, Instagram and Facebook), QR code and email. Descriptive statistics were calculated, and regression analyses were performed to show correlations. RESULTS We analysed the responses of 299 patients and 129 rheumatologists. Most patients (74%) and rheumatologists (76%) believed that DHAs are useful in the management of rheumatic and musculoskeletal diseases (RMDs) and felt confident in their own usage thereof (90%; 86%). 38% of patients and 71% of rheumatologists reported that their attitude had changed positively towards DHAs and that their usage had increased due to COVID-19 (29%; 48%). The majority in both groups agreed on implementing virtual visits for follow-up appointments in stable disease conditions. The most reported advantages of DHAs were usage independent of time and place (76.6%; 77.5%). The main barriers were a lack of information on suitable, available DHAs (58.5%; 41.9%), poor usability (42.1% of patients) and a lack of evidence supporting the effectiveness of DHAs (23.2% of rheumatologists). Only a minority (<10% in both groups) believed that digitalisation has a negative impact on the patient-doctor relationship. CONCLUSION The COVID-19 pandemic instigated an increase in patients' and rheumatologists' acceptance and usage of DHAs, possibly introducing a permanent paradigm shift in the management of RMDs.
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Affiliation(s)
- Anna Kernder
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Harriet Morf
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Philipp Klemm
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Immunology, Osteology, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
| | - Diana Vossen
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, St. Elisabeth Hospital, Meerbusch, Germany
| | - Isabell Haase
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Johanna Mucke
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | - Marco Meyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Rheumatology, Bad Bramdsted Hospital, Bad Bramstedt, Germany
| | - Arnd Kleyer
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Philipp Sewerin
- Department of Rheumatology & Hiller Research Unit, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany
| | | | - Sabine Eis
- Deutsche Rheuma-Liga Bundesverband e.V, Bonn, Germany
| | - Johannes Knitza
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany.,Department of Internal Medicine 3 - Rheumatology and Immunology, Erlangen University Hospital, Erlangen, Germany
| | - Martin Krusche
- Working Group Young Rheumatology, German Society for Rheumatology, Berlin, Germany .,Deaprtment of Rheumatology and Clinical immunology, Charite Medical Faculty Berlin, Berlin, Germany
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