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Butler S, Sculley D, Santos D, Girones X, Singh-Grewal D, Coda A. Paediatric Rheumatology Fails to Meet Current Benchmarks, a Call for Health Equity for Children Living with Juvenile Idiopathic Arthritis, Using Digital Health Technologies. Curr Rheumatol Rep 2024; 26:214-221. [PMID: 38466514 PMCID: PMC11116247 DOI: 10.1007/s11926-024-01145-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE OF REVIEW This critical review begins by presenting the history of Juvenile Idiopathic Arthritis (JIA) management. To move the conversation forward in addressing the current shortcomings that exist in the clinical management of children living with JIA, we argue that to date, the advancement of successful treatments for JIA has been historically slow. Factors implicated in this situation include a lack of rigorous research, JIA being considered a rare disease, and JIA's idiopathic and complex pathophysiology. RECENT FINDINGS Despite the well-intended legislative changes to increase paediatric research, and the major advancements seen in molecular medicine over the last 30 years, globally, paediatric rheumatology services are still failing to meet the current benchmarks of best practice. Provoking questions on how the longstanding health care disparities of poor access and delayed treatment for children living with JIA can be improved, to improve healthcare outcomes. Globally, paediatric rheumatology services are failing to meet the current benchmarks of best practice. Raising awareness of the barriers hindering JIA management is the first step in reducing the current health inequalities experienced by children living with JIA. Action must be taken now, to train and well-equip the paediatric rheumatology interdisciplinary workforce. We propose, a resource-efficient way to improve the quality of care provided could be achieved by embedding digital health into clinical practice, to create an integrative care model between the children, general practice and the paediatric rheumatology team. To improve fragmented service delivery and the coordination of interdisciplinary care, across the healthcare system.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW, 2258, Australia.
| | - Dean Sculley
- School of Bioscience and Pharmacy, University of Newcastle, 10 Chittaway Rd, Ourimbah, NSW, 2258, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Musselburgh, EH21 6UU, UK
| | - Xavier Girones
- Faculty of Health Sciences, Universities de Catalunya, Via Laietana, 2. Planta 4, 08003, Barcelona, Spain
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children's Hospitals Network, Randwick and Westmead, Westmead, NSW, 2145, Australia
- John Hunter Children's Hospital, New Lambton Heights, NSW, 2305, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Camperdown, NSW, 2006, Australia
- School of Women's and Children's Health, University of NSW, Sydney, NSW, 2052, Australia
| | - Andrea Coda
- School of Health Sciences, University of Newcastle, Chittaway Rd, Ourimbah, NSW, 2258, Australia
- 'Equity in Health and Wellbeing Research Program' at the Hunter Medical Research Institute (HMRI), Lot 1, Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2024; 22:59. [PMID: 38807125 DOI: 10.1186/s12969-024-00994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). METHODS Caregivers (n = 22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤ 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. RESULTS Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. CONCLUSION These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to loss to follow-up. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Affiliation(s)
- Naira Ikram
- Harvard Medical School, 02115, Boston, MA, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD, 20892-1102, USA.
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA.
| | - Melissa H Watt
- Department of Population Health Sciences, University of Utah, Utah, USA
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape, South Africa
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Venuturupalli S, Peck A, Jinka Y, Fortune N, Davuluri N, Nowell WB, Gavigan K, Cush J, Soares N, Grainger R, Curtis JR. Home-Based Telemedicine in Rheumatology-A Scoping Review. ACR Open Rheumatol 2024; 6:312-320. [PMID: 38456334 PMCID: PMC11089445 DOI: 10.1002/acr2.11660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVE We performed a scoping review of the relevant literature on home-based telehealth in rheumatology to understand its appropriate application in rheumatology practice. METHODS We searched the Cochrane Library, PubMed, Web of Science, and scientific meeting abstracts to identify articles that specifically addressed telehealth suitability, barriers to telehealth, patient-reported outcomes (PROs) collected in telehealth settings, and telehealth satisfaction. From the initial search of 4,882 studies, 23 reports were included. In addition, 10 abstracts were also eligible for analysis, resulting in a total of 33 articles: 2 randomized clinical trials, 9 prospective cohort studies, and 22 retrospective studies. RESULTS We found that triage appointments or predictive models could be helpful in selecting patients for telehealth and that telehealth interventions were appropriate for follow-up of patients with systemic lupus erythematosus and inflammatory arthritis, but that conducting new patient visits over telehealth was not ideal. Barriers to telehealth include patient factors (age, technology access) and need for physician/process factors (eg, physical examinations). PROs collected in regular practice can be incorporated into telehealth. Several small, single-center studies suggest that telehealth does not lead to negative outcomes compared with in-person visits, and overall, patients report high patient satisfaction with telehealth. In several scenarios, home-based telehealth was equivalent to in-person visits with regard to patient outcomes and satisfaction. CONCLUSION The widespread potential of telehealth to manage and deliver care for people with rheumatic disease is significant. As such, further research in the form of randomized controlled trials can help contribute to growing evidence that shapes telehealth implementation for patients with rheumatic diseases.
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Affiliation(s)
- Swamy Venuturupalli
- Cedars Sinai Medical Center, University of California Los Angeles, and Attune HealthLos AngelesCalifornia
| | - Alexander Peck
- Cedars Sinai Medical Center and Pacific Arthritis Care CenterLos AngelesCalifornia
| | | | | | | | | | | | - John Cush
- Texas Christian University Burnett School of MedicineFort Worth
| | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of MedicineKalamazoo
| | - Rebecca Grainger
- Te Whatu Ora Health New Zealand Capital Coast and Hutt Valley and University of Otago WellingtonWellingtonNew Zealand
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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. RESEARCH SQUARE 2024:rs.3.rs-3919073. [PMID: 38464004 PMCID: PMC10925452 DOI: 10.21203/rs.3.rs-3919073/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). Methods: Caregivers (n=22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth ( < 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to attrition. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Khubchandani R, Avčin T, Ravelli A. Towards telehealth delivery in pediatric rheumatology practice. Pediatr Rheumatol Online J 2023; 21:145. [PMID: 38105249 PMCID: PMC10726584 DOI: 10.1186/s12969-023-00892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Much has been written and spoken about telemedicine since about two decades including an article in this journal at the start of the pandemic. It took a global catastrophe to enforce its usage across the world in various medical specialties. Telemedicine however remains unstructured, unregulated and lacks uniformity. DISCUSSION This article highlights the practical learnings and opinions of the authors who provided over two thousand video consults and asynchronous telemedicine services through the entire pandemic. It includes lessons learnt from emerging economies where pediatric rheumatologists are scarce. Pediatric rheumatology, which relies heavily on history, musculoskeletal and skin examination is aptly suited to exploit telemedicine in its synchronous and asynchronous forms. Pediatric tele rheumatology could temporarily address the shortage and uneven distribution of specialists in vast parts of the globe, besides serving as a method of triage and shared care with the primary physician. Reduction of direct and indirect costs and family/primary physician education are additional benefits. There also exist challenges for all stakeholders and it is important to address the latter. CONCLUSION The learnings of the pandemic suggest a vital role for telemedicine in the practice of pediatric rheumatology. This is a fertile area for research and consensus building by international and national pediatric societies and issue position statements like some adult bodies already have. The authors speculate a hybrid system of care in the not-so-distant future.
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Affiliation(s)
- Raju Khubchandani
- Section of Pediatric Rheumatology, SRCC Childrens Hospital, K Khadye Marg Mumbai, Mumbai, India.
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
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Kayaalp GK, Akgün Ö, Demirkan FG, Tanatar A, Çakmak F, Ayaz NA. Parent Views on Telemedicine in Pediatric Rheumatology: A Survey Study. Telemed J E Health 2023; 29:1548-1556. [PMID: 36800172 DOI: 10.1089/tmj.2022.0433] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Objectives: The rapid expansion in the use of telemedicine after the COVID-19 pandemic has led many patients with chronic diseases to seek alternative ways for follow-ups. This study aimed to investigate the demands and opinions of parents of children with rheumatic diseases toward telemedicine and to examine the factors affecting telemedicine preference. Methods: A single-center, cross-sectional, Web-based survey study was conducted. Sociodemographic data, characteristics of the disease, access to the clinic, internet use, and views on telemedicine were assessed. Factors effecting telemedicine preference were evaluated by multivariate analysis. Results: A total of 245 parents have completed the survey. The diagnoses of patients were recurrent fever syndromes (55.1%), juvenile idiopathic arthritis (31.0%), systemic connective tissue diseases (8.2%), and vasculitis (5.7%). The majority of patients came to the clinic by public transport (n = 190, 77.6%). Sixty-eight (27.8%) patients missed at least one outpatient appointment in the last year. Majority (n = 172, 70.2%) of parents stated that they would prefer telemedicine visits if it becomes available. Multivariate analysis revealed that the most related factors to telemedicine preference were higher education level (odds ratio [OR]: 6.69, confidence interval [95% CI]: 2.21-20.25, p = 0.001), missing an appointment (OR: 3.04, 95% CI: 1.41-6.56, p = 0.004), and travel time longer than 1 h (OR: 2.13, 95% CI: 1.13-3.86, p = 0.012). Conclusion: Telemedicine visits are in demand in pediatric rheumatology and should be considered an alternative method to ensure continuity of patient follow-up. A personal approach should be followed when selecting patients for telemedicine.
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Affiliation(s)
- Gülşah Kavrul Kayaalp
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Özlem Akgün
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Esposito S, Rosafio C, Antodaro F, Argentiero A, Bassi M, Becherucci P, Bonsanto F, Cagliero A, Cannata G, Capello F, Cardinale F, Chiriaco T, Consolaro A, Dessì A, Di Mauro G, Fainardi V, Fanos V, Guarino A, Li Calzi G, Lodi E, Maghnie M, Manfredini L, Malorgio E, Minuto N, Modena MG, Montori R, Moscatelli A, Patrone E, Pescio E, Poeta M, Ravelli A, Spelta M, Suppiej A, Vai S, Villa L, Zanini R, Botti R, Gaddi AV. Use of Telemedicine Healthcare Systems in Children and Adolescents with Chronic Disease or in Transition Stages of Life: Consensus Document of the Italian Society of Telemedicine (SIT), of the Italian Society of Preventive and Social Pediatrics (SIPPS), of the Italian Society of Pediatric Primary Care (SICuPP), of the Italian Federation of Pediatric Doctors (FIMP) and of the Syndicate of Family Pediatrician Doctors (SIMPeF). J Pers Med 2023; 13:jpm13020235. [PMID: 36836469 PMCID: PMC9965862 DOI: 10.3390/jpm13020235] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/01/2023] Open
Abstract
Telemedicine is considered an excellent tool to support the daily and traditional practice of the health profession, especially when referring to the care and management of chronic patients. In a panorama in which chronic pathologies with childhood onset are constantly increasing and the improvement of treatments has allowed survival for them into adulthood, telemedicine and remote assistance are today considered effective and convenient solutions both for the chronic patient, who thus receives personalized and timely assistance, and for the doctors, who reduce the need for direct intervention, hospitalizations and consequent management costs. This Consensus document, written by the main Italian Scientific Societies involved in the use of telemedicine in pediatrics, has the objectives to propose an organizational model based on the relationships between the actors who participate in the provision of a telemedicine service aimed at minors with chronic pathologies, identifying specific project links between the areas of telemedicine in the developmental age from the first 1000 days of life to the age adult. The future scenario will have to be able to integrate digital innovation in order to offer the best care to patients and citizens. It will have to be able to provide the involvement of patients from the very beginning of the design of any care pathway, increasing where possible the proximity of the health service to citizens.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
- Correspondence:
| | | | | | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Marta Bassi
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | | | | | | | - Giulia Cannata
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Fabio Capello
- UO Territorial Pediatrics, Primary Care Department, AUSL Bologna, 40126 Bologna, Italy
| | - Fabio Cardinale
- UOC of Pediatrics and ED with an Allergy-Pneumological and Immuno-Rheumatological Focus, Giovanni XXIII Pediatric Hospital, University of Bari, 70124 Bari, Italy
| | - Tiziana Chiriaco
- Health Department, ASL Roma 3, 00125 Rome, Italy
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Alessandro Consolaro
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
| | - Angelica Dessì
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | | | - Valentina Fainardi
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Vassilios Fanos
- Department of Surgical Sciences, University of Cagliari, 09127 Cagliari, Italy
| | - Alfredo Guarino
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Giada Li Calzi
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Lodi
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Mohamad Maghnie
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Luca Manfredini
- Pediatric Pain and Palliative Care Service, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | | | - Nicola Minuto
- Department of Pediatrics, IRCCS Giannina Gaslini, 16147 Genoa, Italy
| | - Maria Grazia Modena
- P.A.S.C.I.A. Center (Heart Failure Care Program, Childhood Heart Diseases and Those at Risk), University of Modena and Reggio Emilia, AOU Polyclinic of Modena, 41124 Modena, Italy
| | - Rossano Montori
- Community Medicine and Primary Care, AUSL Modena, 41124 Modena, Italy
| | - Andrea Moscatelli
- UOC Anesthesia and Intensive Care, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Elisa Patrone
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | - Elena Pescio
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Marco Poeta
- Section of Pediatrics, Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Sciences (DINOGMI), University of Genoa, 16126 Genoa, Italy
- Scientific Directorate, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Maddalena Spelta
- Pediatric and Rheumatology Clinic, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Agnese Suppiej
- Pediatric Clinic, University of Ferrara, 44124 Ferrara, Italy
| | | | - Luca Villa
- UOSID Trial Center, IRCCS Giannina Gaslini Institute, 16147 Genoa, Italy
| | | | - Renato Botti
- General Management, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Antonio Vittorino Gaddi
- Center for Metabolic Diseases and Atherosclerosis, University of Bologna, 40126 Bologna, Italy
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Aboye GT, Vande Walle M, Simegn GL, Aerts JM. mHealth in sub-Saharan Africa and Europe: A systematic review comparing the use and availability of mHealth approaches in sub-Saharan Africa and Europe. Digit Health 2023; 9:20552076231180972. [PMID: 37377558 PMCID: PMC10291558 DOI: 10.1177/20552076231180972] [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] [Received: 10/19/2022] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Background mHealth can help with healthcare service delivery for various health issues, but there's a significant gap in the availability and use of mHealth systems between sub-Saharan Africa and Europe, despite the ongoing digitalization of the global healthcare system. Objective This work aims to compare and investigate the use and availability of mHealth systems in sub-Saharan Africa and Europe, and identify gaps in current mHealth development and implementation in both regions. Methods The study adhered to the PRISMA 2020 guidelines for article search and selection to ensure an unbiased comparison between sub-Saharan Africa and Europe. Four databases (Scopus, Web of Science, IEEE Xplore, and PubMed) were used, and articles were evaluated based on predetermined criteria. Details on the mHealth system type, goal, patient type, health concern, and development stage were collected and recorded in a Microsoft Excel worksheet. Results The search query produced 1020 articles for sub-Saharan Africa and 2477 articles for Europe. After screening for eligibility, 86 articles for sub-Saharan Africa and 297 articles for Europe were included. To minimize bias, two reviewers conducted the article screening and data retrieval. Sub-Saharan Africa used SMS and call-based mHealth methods for consultation and diagnosis, mainly for young patients such as children and mothers, and for issues such as HIV, pregnancy, childbirth, and child care. Europe relied more on apps, sensors, and wearables for monitoring, with the elderly as the most common patient group, and the most common health issues being cardiovascular disease and heart failure. Conclusion Wearable technology and external sensors are heavily used in Europe, whereas they are seldom used in sub-Saharan Africa. More efforts should be made to use the mHealth system to improve health outcomes in both regions, incorporating more cutting-edge technologies like wearables internal and external sensors. Undertaking context-based studies, identifying determinants of mHealth systems use, and considering these determinants during mHealth system design could enhance mHealth availability and utilization.
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Affiliation(s)
- Genet Tadese Aboye
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
- School of Biomedical Engineering, Jimma University, Jimma, Ethiopia
| | - Martijn Vande Walle
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | | | - Jean-Marie Aerts
- M3-BIORES (Measure, Model & Manage Bioreponses), Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
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Makhlouf Y, Nessib DB, Ferjani H, Triki W, Maatallah K, Dhia K, Hamdi. The concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions. J Pediatr Nurs 2022; 69:6-9. [PMID: 36584592 PMCID: PMC9797351 DOI: 10.1016/j.pedn.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 11/29/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION With the COVID-19 pandemic, health care systems are facing challenges in delivering proper patient care. Children and adolescents with juvenile idiopathic arthritis require specialized and comprehensive attention. In this context, telemedicine is an alternative that has the potential to improve access to healthcare in addition to cost savings. The objective of our study was to evaluate parents' willingness for telemedicine and factors helping to adopt this alternative in the era of COVID-19. METHODS We undertook a cross-sectional study via structured phone interviews of parents' JIA patients as well as those with no established diagnoses. We evaluated their point of view and willingness to adhere to TM. RESULTS The study included 40 parents. The main reasons for favoring TM were avoiding hospitals during the pandemic (32.5%), time saving (27.5%) as well as avoiding school absenteeism (27.5%). The main reasons for preferring a live consultation were the fear of a possible discrepancy between physical and distant evaluation (47.5%) and the fear of the trivialization of the disease (38.5%). There was no association between preference for TM and a family history of COVID-19 (p = 0.704) as well as electronic devices afforded (p = 0.263). However, patients who lived away from hospital, not familiar with the concept of TM and with higher income adhered less to TM. CONCLUSION Unlike the literature data, our study showed the low prevalence of parents willing to accept TM as a model of care. This imply an urgent need for parent and patient education to promote TM especially in pediatric rheumatology.
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Affiliation(s)
- Yasmine Makhlouf
- Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia.
| | - Dorra Ben Nessib
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Hanene Ferjani
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia.
| | - Wafa Triki
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Kaouther Maatallah
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Kaffel Dhia
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
| | - Hamdi
- University of Tunis El Manar Faculty of Medicine of Tunis, Tunis, Tunisia; Mohammed Kassab National Institute of Orthopaedics, Rheumatology department, La Mannouba, Tunisia
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10
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Giray E, Kenis-Coskun O, Karadag-Saygi E, Ozyemisci-Taskiran O. Interrater Reliability, Acceptability, and Practicality of Real-Time Video Pediatric Gait, Arms, Legs, and Spine for Musculoskeletal Assessment of Children During Telemedicine Visits. J Clin Rheumatol 2022; 28:235-239. [PMID: 35319535 DOI: 10.1097/rhu.0000000000001840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVE With the COVID-19 (coronavirus disease 2019) pandemic, telemedicine applications gained momentum, and clinicians tried to develop various musculoskeletal examination methods to be used in telemedicine visits. The aim of this study is to investigate the interrater reliability, acceptability, and practicality of the real-time video Pediatric Gait, Arms, Legs, and Spine (v-pGALS) assessment used in the evaluation during the telemedicine visit. METHODS The study was designed as cross-sectional. Twenty school-aged children who presented to outpatient clinics with musculoskeletal complaints were included. For interrater reliability, the children were evaluated by face-to-face examination with v-pGALS, and then the child was reevaluated by another physiatrist with real-time evaluation (online video call) with the help of a parent. For acceptability, the time taken and the discomfort caused were evaluated by patients/parents with the smiley face visual analog scale, whereas to assess practicality, the ratio of completeness to duration of examination completion was recorded. RESULTS κ coefficient of the agreement was found to be 0.88 between the results of the face-to-face examination and online video examination, suggesting very good agreement between the 2 raters. Acceptability of v-pGALS by parents and patients was high; 60% of children and 80% of parents found the duration of examination acceptable, and 70% of the patients and 95% of parents reported no discomfort caused by examination. The duration of face-to-face examination was 5.75 ± 1.29 minutes, whereas the duration of online examination was 15.81 ± 4.9 minutes. CONCLUSIONS Video pGALS is a reliable, acceptable, and practical examination system that can be used for musculoskeletal assessment of children in telemedicine visits.
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Affiliation(s)
- Esra Giray
- From the Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Research and Training Hospital
| | - Ozge Kenis-Coskun
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Evrim Karadag-Saygi
- Department of Physical Medicine and Rehabilitation, Marmara University School of Medicine
| | - Ozden Ozyemisci-Taskiran
- Department of Physical Medicine and Rehabilitation, Koç University School of Medicine, Istanbul, Turkey
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11
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Soscia F, Sicignano LL, Verrecchia E, Ardenti Morini F, Massaro MG, Civitelli FS, Ferrari F, Rigante D, Cortis E, Manna R. Transitional care management in patients with auto-inflammatory diseases: experience of cooperation of a paediatric and adult centre. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Auto-inflammatory Diseases (AIDs) are a group of diseases with a strong genetic component, inducing an inappropriate activation of innate immunity. The patients with pediatric onset will face the transitional care (TC) from a pediatrician to an adult care setting, during the critical phase of the adolescence. That implies a risk of failure and drop out, due to the different approach of pediatrician compared to the adult doctor. To describe the model of TC for AIDs from a paediatric to adult centre of two hospitals in Rome, and to pointing out the different steps emerged from specific experiences.
Methods
In November 2020, a Board of paediatricians and internists discussed their experience to identify “hot topics” for a successful management of TC.
Results
The Board agreed on the optimal time for the transition (12–18 years). Specific elements to be considered are the reached level of emotional and intellectual maturity, and the clinical stability of the disease.
Conclusions
The TC of patients with chronic AIDs, requires a strong cooperation to define the adequate follow-up, and to guarantee the compliance to the treatment. This model allows us to investigate AIDs complex cases, requiring a long period of observations.
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Affiliation(s)
| | - Ludovico Luca Sicignano
- Periodic Fevers and Rare Diseases Research Center, Catholic University , Rome , Italy
- Department of Geriatrics , Neurosciences and Orthopedics, A. Gemelli Foundation, IRCCS , Rome , Italy
| | - Elena Verrecchia
- Periodic Fevers and Rare Diseases Research Center, Catholic University , Rome , Italy
- Department of Geriatrics , Neurosciences and Orthopedics, A. Gemelli Foundation, IRCCS , Rome , Italy
| | | | - Maria Grazia Massaro
- Periodic Fevers and Rare Diseases Research Center, Catholic University , Rome , Italy
- Department of Geriatrics , Neurosciences and Orthopedics, A. Gemelli Foundation, IRCCS , Rome , Italy
| | | | | | - Donato Rigante
- Periodic Fevers and Rare Diseases Research Center, Catholic University , Rome , Italy
- Department of Life Sciences and Public Health , Fondazione Policlinico A. Gemelli IRCCS , Rome , Italy
| | | | - Raffaele Manna
- Periodic Fevers and Rare Diseases Research Center, Catholic University , Rome , Italy
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12
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Telehealth in rheumatology: the 2021 Arab League of Rheumatology Best Practice Guidelines. Rheumatol Int 2022; 42:379-390. [PMID: 34993578 PMCID: PMC8735733 DOI: 10.1007/s00296-021-05078-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/14/2022]
Abstract
To develop Best Practice Guidelines (BPG) for the use of Telehealth in Rheumatology in the Arab region, to identify the main barriers and facilitators of telehealth, and to provide rheumatologists with a practical toolkit for the implementation of telehealth. 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 statements were included in the final BPG without further voting if ≥ 80% of TF members indicated high agreement. 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. Four General Principles and twelve Statements were formulated. 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. The ArLAR BPG provide rheumatologists with a series of strategies about the most reliable, productive, and rational approaches to apply telehealth.
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13
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Madenidou AV, Yeoh S. Telerheumatology during the COVID-19 pandemic: Impact on clinical practice, education, and research. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_229_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Waqar-Cowles LN, Chuo J, Weiss PF, Gmuca S, LaNoue M, Burnham JM. Evaluation of pediatric rheumatology telehealth satisfaction during the COVID-19 pandemic. Pediatr Rheumatol Online J 2021; 19:170. [PMID: 34886863 PMCID: PMC8655491 DOI: 10.1186/s12969-021-00649-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 11/14/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the Coronavirus disease 2019 pandemic, ambulatory pediatric rheumatology healthcare rapidly transformed to a mainly telehealth model. However, pediatric patient and caregiver satisfaction with broadly deployed telehealth programs remains largely unknown. This study aimed to evaluate patient/caregiver satisfaction with telehealth and identify the factors associated with satisfaction in a generalizable sample of pediatric rheumatology patients. METHODS Patients with an initial telehealth video visit with a rheumatology provider between April and June 2020 were eligible. All patients/caregivers were sent a post-visit survey to assess a modified version of the Telehealth Usability Questionnaire (TUQ) and demographic and clinical characteristics. TUQ total and sub-scale (usefulness, ease of use, effectiveness, satisfaction) scores were calculated and classified as "positive" based on responses of "agree" or "strongly agree" on a 5-point Likert scale. Results were analyzed using standard descriptive statistics and Wilcoxon signed rank testing. The association between demographic and clinical characteristics with TUQ scores was assessed using univariate linear regression. RESULTS 597 patients/caregivers met inclusion criteria, and the survey response rate was 42% (n = 248). Juvenile idiopathic arthritis was the most common diagnosis (33.5%). The majority of patients were diagnosed greater than 6 months previously (72.6%) and were prescribed chronic medications (59.7%). The median total TUQ score was 4 (IQR: 4-5) with positive responses in 81% of items. Of the subscales, usefulness scores were lowest (median: 4, p < 0.001). Telehealth saves time traveling was the highest median item score (median = 5, IQR: 4-5). Within subscales, items that scored significantly lower included convenience, providing for needs, seeing rheumatologist as well as in person, and being an acceptable way to receive rheumatology services (all p < 0.001). There were no significant demographic or clinical features associated with TUQ scores. CONCLUSIONS Our results suggest telehealth is a promising mode of healthcare delivery for pediatric rheumatic diseases but also identifies opportunities for improvement. Innovation and research are needed to design a telehealth system that delivers high quality and safe care that improves healthcare outcomes. Since telehealth is a rapidly emerging form of pediatric rheumatology care, improved engagement and training of patients, caregivers, and providers may help improve the patient experience in the future.
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Affiliation(s)
- Lindsay N. Waqar-Cowles
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.265008.90000 0001 2166 5843College of Population Health, Thomas Jefferson University, Philadelphia, PA 19107 USA
| | - John Chuo
- grid.239552.a0000 0001 0680 8770Division of Neonatology, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Pamela F. Weiss
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Sabrina Gmuca
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770PolicyLab, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA 19146 USA
| | - Marianna LaNoue
- grid.152326.10000 0001 2264 7217Center for Research and Scholarly Development, Vanderbilt University School of Nursing, Nashville, TN 37203 USA
| | - Jon M. Burnham
- grid.239552.a0000 0001 0680 8770Division of Rheumatology, Children’s Hospital of Philadelphia, 3501 Civic Center Blvd., CTRB 1100.16, Philadelphia, PA 19104 USA ,grid.25879.310000 0004 1936 8972Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
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15
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Pooni R, Lee T. The Emerging Telehealth Landscape in Pediatric Rheumatology. Rheum Dis Clin North Am 2021; 48:259-270. [PMID: 34798951 DOI: 10.1016/j.rdc.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
This article provides an in-depth review of telemedicine and its use in pediatric rheumatology. Historical barriers to the use of telemedicine in pediatric chronic care are described, and recent policy changes that have supported the use of telemedicine are discussed. Future directions and suggestions for the evaluation of telemedicine in pediatric rheumatology care are provided with a special focus on clinical outcomes, its use in research, patient acceptability, and health equity.
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Affiliation(s)
- Rajdeep Pooni
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA.
| | - Tzielan Lee
- Division of Allergy, Immunology and Rheumatology, Department of Pediatric Rheumatology, Stanford Children's Health, Stanford University School of Medicine, 700 Welch Road, Suite 301, Palo Alto, CA 94304, USA
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16
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Welcoming Healthcare Into Our Virtual Meeting Rooms: Perspective and Perseverance in Pediatric Rheumatology. CURRENT PEDIATRICS REPORTS 2021; 9:162-166. [PMID: 34631303 PMCID: PMC8488317 DOI: 10.1007/s40124-021-00252-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 11/22/2022]
Abstract
Purpose of Review We highlight practice changes adopted to increased use of telemedicine, look at precision, and accuracy in using a virtual visit to evaluate and treat rheumatic disease, and describe our shift in engaging patients and their families in supporting our research aims. Recent Findings Telemedicine visits increased substantially with the start of the SARS-CoV-2 pandemic. With this change came the need for significant advances to our telemedicine practices to allow for quality patient visits and continued research collection. Summary Telemedicine will continue to be an area of increasing importance and has been found to be especially useful for regions like ours which cover many patients in remote areas across Washington, Wyoming, Idaho, Montana, and Alaska. Through the development of new techniques and the use of new technologies, we have been able to improve both the visit quality for patients and our ability to collect research data.
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17
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Wahezi DM, Peskin M, Tanner T. The impact of the COVID-19 pandemic on the field of pediatric rheumatology. Curr Opin Rheumatol 2021; 33:446-452. [PMID: 34175864 PMCID: PMC8373393 DOI: 10.1097/bor.0000000000000814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to discuss the clinical management of children with pediatric rheumatic disease (PRD) during the Coronavirus disease of 2019 (COVID-19) pandemic, as well as the unique role of the pediatric rheumatologist during a time of emerging post-COVID inflammatory sequelae including, multisystem inflammatory syndrome in children (MIS-C). RECENT FINDINGS To date, there has been little evidence to suggest that children with PRD, including those on immunomodulatory therapies, are at increased risk for severe COVID-19. Clinical guidance statements have been created to support clinical providers in providing care to children with PRD during the COVID-19 pandemic. Pediatric rheumatologists have also been called upon to assist in the identification and management of post-COVID sequelae, including the rapidly emerging inflammatory illness, MIS-C. SUMMARY The COVID-19 era has been defined by a rapid expansion in scientific knowledge and a time of extraordinary local and worldwide collaboration, both within the pediatric rheumatology community, as well as across multiple disciplines. Through collective efforts, we have learned that children with PRD, including those on immunomodulatory therapies, are not at increased risk for severe COVID-19. Pediatric rheumatologists have also worked alongside other disciplines to develop guidance for the management of MIS-C, with the majority of patients experiencing excellent clinical outcomes.
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Affiliation(s)
- Dawn M Wahezi
- Division of Pediatric Rheumatology, Children's Hospital at Montefiore, The University Hospital for Albert Einstein College of Medicine, New York, USA
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18
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McDonagh JE, Tattersall R, Clinch J, Swan J, Foster HE, McCann L. Developmentally appropriate transitional care during the Covid-19 pandemic for young people with juvenile-onset rheumatic and musculoskeletal diseases: the rationale for a position statement. Pediatr Rheumatol Online J 2021; 19:136. [PMID: 34433477 PMCID: PMC8386148 DOI: 10.1186/s12969-021-00609-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of developmentally appropriate transitional care in young people with juvenile-onset rheumatic and musculoskeletal disease is well recognised. The Paediatric Rheumatology European Society (PReS) / European League Against Rheumatism (EULAR) Taskforce has developed international recommendations and standards for transitional care and a growing evidence base supports the positive benefits of such care. However, there is also evidence that universal implementation has yet to be realised. In 2020, against this background the COVID-19 pandemic arrived with significant impact on all our lives, young and old, patient, public and professional alike. The unfortunate reality of the pandemic with potential for unfavourable outcomes on healthcare provision during transition was acknowledged by the PReS working groups in a position statement to support healthcare professionals, young people and their caregivers. AIM The aim of this review is to present the literature which provides the rationale for the recommendations in the PReS Position Statement. The following areas are specifically addressed: the prime importance of care coordination; the impact of the pandemic on the various aspects of the transition process; the importance of ensuring continuity of medication supply; the pros and cons of telemedicine with young people; ensuring meaningful involvement of young people in service development and the importance of core adolescent health practices such as routine developmental assessment psychosocial screening and appropriate parental involvement during transitional care.
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Affiliation(s)
- Janet E. McDonagh
- Versus Arthritis Centre for Epidemiology; Centre for MSK Research, University of Manchester, Stopford Building, 2nd floor, Oxford Rd, Manchester, M13 9PT UK
- NIHR Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Rachel Tattersall
- Sheffield Children’s Hospital and Sheffield Teaching Hospitals, Manchester, UK
| | - Jacqui Clinch
- Bristol Royal Hospital for Children and Royal National Hospital for Rheumatic Diseases, Bath, UK
| | - Joanne Swan
- Public Health Family Nurse, Family Nurse Partnership, Wallacetown Health Centre, NHS Tayside, Dundee, UK
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
| | - Helen E. Foster
- Paediatric Rheumatology, Newcastle University, Newcastle upon Tyne, UK
- Honorary Consultant Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Chair Paediatric Global Musculoskeletal Task Force, Manchester, UK
| | - Liza McCann
- Paediatric Rheumatology European Society (PReS) Juvenile Dermatomyositis Working Party, Manchester, UK
- Consultant Paediatric Rheumatologist, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
- Honorary Clinical Senior Lecturer, University of Liverpool, Liverpool, UK
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19
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Pedretti A, Márquez Fosser S, Pasquinelli R, Vallone M, Plazzotta F, Luna D, Martínez B, Rodríguez P, Florencia Grande Ratti M. Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021; 78. [PMID: 34617705 PMCID: PMC8760909 DOI: 10.3105310.31053/1853.0605.v78.n3.32414] [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: 11/24/2022] Open
Abstract
Introduction To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.
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Affiliation(s)
- Ana Pedretti
- Department of Internal Medicine, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Santiago Márquez Fosser
- Department of Internal Medicine, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina,Clinical and Health Informatics Research Group, McGill UniversityMontréalQuébecCanada,Department of Health Informatics, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Rosario Pasquinelli
- Department of Internal Medicine, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Marcelo Vallone
- Department of Internal Medicine, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Fernando Plazzotta
- Department of Health Informatics, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Daniel Luna
- Department of Health Informatics, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina
| | - Bernardo Martínez
- Department of Internal Medicine, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina,Emergency Department, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Paz Rodríguez
- Emergency Department, Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - María Florencia Grande Ratti
- Department of Health Informatics, Hospital Italiano de Buenos AiresCiudad de Buenos AiresArgentina,Emergency Department, Hospital Italiano de Buenos AiresBuenos AiresArgentina,Internal Medicine Research Unit, Hospital Italiano de Buenos AiresBuenos AiresArgentina
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20
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Pedretti A, Marquez Fosser S, Pasquinelli R, Vallone M, Plazzotta F, Luna D, Martinez B, Rodriguez P, Grande Ratti MF. Risk of readmission to the emergency department in mild COVID-19 outpatients with telehealth follow-up. REVISTA DE LA FACULTAD DE CIENCIAS MÉDICAS 2021; 78:249-256. [PMID: 34617705 PMCID: PMC8760909 DOI: 10.31053/1853.0605.v78.n3.32414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/21/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction To describe patients´ characteristics of confirmed COVID-19 with mild symptoms discharged home from the Emergency Department (ED) and followed using telemedicine, to estimate ED-readmission rates and hospitalization, and to explore associated factors with these clinical outcomes. Methods We performed a retrospective cohort study in Hospital Italiano de Buenos Aires from June to August 2020, which included patients with mild COVID-19 symptoms, diagnosed with a positive result. Follow-up occurred from discharged until ED-readmission or 14 days. We estimate cumulative incidence using the Kaplan-Meier model and associated factors using logistic regression. Results We included 1,239 patients, with a median of 41 years and 53.82% male. A total of 167 patients were readmitted to the ED within 14 days, with a global incidence rate of 13.08% (95%CI 11.32-15.08). Of these, 83 required hospitalization (median time from diagnosis 4.98 days), 5.98% was not related to any COVID-19 complication, and five patients died. After adjustment by confounders (age ≥65, sex, diabetes, hypertension, former smoking, active smoking, fever, diarrhea, and oxygen saturation), we found significant associations: former smoking (adjusted OR 2.09, 95% CI 1.31-3.34, p0 .002), fever (aOR 1.56, 95% CI 1.07-2.28, p0.002) and oxygen saturation (aOR 0.82, 95% CI 0.71-0.95, p0.009). Conclusion The 13% rate of ED-readmission during 14 days of follow-up of mild symptomatic COVID-19 patients initially managed as outpatients with telehealth is highly significant in hospital management, quality performance, and patient safety.
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21
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Pooni R, Ronis T, Lee T. Telemedicine use by pediatric rheumatologists during the COVID-19 pandemic. Pediatr Rheumatol Online J 2021; 19:93. [PMID: 34134709 PMCID: PMC8206874 DOI: 10.1186/s12969-021-00565-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/18/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND To characterize various aspects of telemedicine use by pediatric rheumatology providers during the recent pandemic including provider acceptability of telehealth practices, clinical reliability, and clinical appropriateness. METHODS An electronic survey was generated and disseminated amongst the Childhood Arthritis and Rheumatology Research Alliance (CARRA) listserv (n = 547). Survey items were analyzed via descriptive statistics by question. RESULTS The survey response rate was 40.8% (n = 223) with the majority of respondents in an attending-level role. We observed that musculoskeletal components of the exam were rated as the most reliable components of a telemedicine exam and 86.5% of survey respondents reported engaging the patient or patient caregiver to help conduct the virtual exam. However, 65.7% of providers reported not being able to elicit the information needed from a telemedicine visit to make a complete clinical assessment. We also noted areas of disagreement regarding areas of patient engagement and confidentiality. We found that approximately one-third (35.8%) of those surveyed felt that their level of burnout was increased due to telemedicine. CONCLUSION In general, providers found exam reliability (specifically around focused musculoskeletal elements) in telemedicine visits but overall felt that they were unable to generate the information needed to generate a complete clinical assessment. Additionally, there were suggestions that patient engagement and confidentiality varied during telemedicine visits when compared to in-person clinical visits. Further qualitative work is needed to fully explore telemedicine use in pediatric rheumatology.
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Affiliation(s)
- Rajdeep Pooni
- Stanford Cildren's Health, Stanford University School of Medicine, Palo Alto, California, USA.
| | - Tova Ronis
- Children's National Hospital, Washington D.C; George Washington School of Medicine & Health Sciences, Washington DC, USA
| | - Tzielan Lee
- Stanford Cildren's Health, Stanford University School of Medicine, Palo Alto, California, USA
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22
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Wahezi DM, Lo MS, Rubinstein TB, Ringold S, Ardoin SP, Downes KJ, Jones KB, Laxer RM, Pellet Madan R, Mudano AS, Turner AS, Karp DR, Mehta JJ. American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID-19 Pandemic: Version 2. Arthritis Rheumatol 2021; 73:e46-e59. [PMID: 34114365 DOI: 10.1002/art.41772] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID-19) pandemic. METHODS The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1-3, 4-6, and 7-9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus. RESULTS To date, 39 guidance statements have been approved by the task force. Those with similar recommendations were combined to form a total of 33 final guidance statements, all of which received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 5) or high consensus (n = 28). CONCLUSION These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.
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Affiliation(s)
- Dawn M Wahezi
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, New York, New York, United States
| | - Mindy S Lo
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Tamar B Rubinstein
- Children's Hospital at Montefiore and Albert Einstein College of Medicine, New York, New York, United States
| | - Sarah Ringold
- Seattle Children's Hospital, Seattle, Washington, United States
| | - Stacy P Ardoin
- Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, United States
| | - Kevin J Downes
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
| | - Karla B Jones
- Nationwide Children's Hospital and Ohio State University, Columbus, Ohio, United States
| | - Ronald M Laxer
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rebecca Pellet Madan
- New York University Grossman School of Medicine and Hassenfeld Children's Hospital, New York, New York, United States
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia, United States
| | - David R Karp
- University of Texas Southwestern Medical Center, Dallas
| | - Jay J Mehta
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
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23
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Migowa AN, Hadef D, Hamdi W, Mwizerwa O, Ngandeu M, Taha Y, Ayodele F, Webb K, Scott C. Pediatric rheumatology in Africa: thriving amidst challenges. Pediatr Rheumatol Online J 2021; 19:69. [PMID: 33962643 PMCID: PMC8103667 DOI: 10.1186/s12969-021-00557-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent. MAIN BODY This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR). CONCLUSION This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond.
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Affiliation(s)
- Angela N. Migowa
- grid.470490.eAga Khan University Medical College East Africa, Department of Paediatrics and Child Health, 3rd Parklands Avenue, P. O Box 30270, Nairobi, Kenya
| | - Djohra Hadef
- Batna 2 University, Faculty of Medicine, 05000 Ezzohor city, Batna Algeria
| | - Wafa Hamdi
- grid.12574.350000000122959819University of Tunis El Manar, Campus Universitaire Farhat Hached B.P. n° 94 Rommana Tunis, 1068 Tunis, Tunisia
| | - Oscar Mwizerwa
- grid.10818.300000 0004 0620 2260University of Rwanda, KG 11 Ave, Kigali, Rwanda
| | - Madeleine Ngandeu
- grid.412661.60000 0001 2173 8504University of Yaoundé, Boîte Postale 337, Yaoundé, Centre Region Cameroon
| | - Yassmin Taha
- Ahmed Gasim Children’s Hospital Khartoum, Sudan Bahri Street, Downtown, Tuti Island, Bahri, Khartoum State Sudan
| | - Faleye Ayodele
- grid.411278.90000 0004 0481 2583Lagos State University Teaching Hospital, Nigeria 1- 5 Oba Akinjobi Way, Street, Ikeja, Lagos Nigeria
| | - Kate Webb
- grid.7836.a0000 0004 1937 1151University of Cape Town, South Africa Rondebosch, Cape Town, 7700 South Africa
| | - Christiaan Scott
- grid.7836.a0000 0004 1937 1151University of Cape Town, South Africa Rondebosch, Cape Town, 7700 South Africa
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24
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Goh YI, Bullock DR, Taylor J, Pooni R, Lee TC, Vora SS, Yildirim-Toruner C, Morgan EM, Pan N, Harris JG, Warmin A, Wiegand K, Burnham JM, Barbar-Smiley F. Exploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN Network. Front Pediatr 2021; 9:642460. [PMID: 33748049 PMCID: PMC7970043 DOI: 10.3389/fped.2021.642460] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 01/13/2021] [Indexed: 11/13/2022] Open
Abstract
Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) site to collect data about their center's experience with telemedicine during the COVID-19 pandemic. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Responses were received from the majority [19/21 (90%)] of PR-COIN sites. All respondents reported transitioning from in-person to primarily virtual patient visits during the COVID-19 pandemic. All centers reported seeing both new consultations and follow-up patients over telemedicine. Most centers reported using both audio and video conferencing systems to conduct their telemedicine visits. The majority of respondents [13/19 (68%)] indicated that at least 50% of their site's providers consistently used pediatric Gait Arms Legs and Spine (pGALS) to perform active joint count assessments over telemedicine. Over half of the centers [11/19 (58%)] reported collecting patient-reported outcomes (PROs), but the rate of reliably documenting clinical components varied. A few sites [7/19 (37%)] reported performing research-related activity during telemedicine visits. All centers thought that telemedicine visits were able to meet providers' needs and support their continued use when the pandemic ends. Benefits reported with telemedicine visits included convenience and continuity of care for families. Conversely, challenges included limited ability to perform physical exams and varying access to technology. Pediatric rheumatology providers were able to transition to conducting virtual visits during the COVID-19 pandemic. Healthcare providers recognize how telemedicine can enhance their practice, but challenges need to be overcome in order to ensure equitable, sustainable delivery of quality and patient-centered care.
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Affiliation(s)
- Y Ingrid Goh
- Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Danielle R Bullock
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN, United States
| | - Janalee Taylor
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rajdeep Pooni
- Division of Allergy, Immunology and Rheumatology, Stanford Children's Health, Palo Alto, CA, United States
| | - Tzielan C Lee
- Division of Allergy, Immunology and Rheumatology, Stanford Children's Health, Palo Alto, CA, United States
| | - Sheetal S Vora
- Division of Pediatric Rheumatology, Atrium Health Levine Children's Hospital, Charlotte, NC, United States
| | - Cagri Yildirim-Toruner
- Department of Rheumatology, Baylor College of Medicine, Houston, TX, United States.,Department of Rheumatology, Texas Children's Hospital, Houston, TX, United States
| | - Esi M Morgan
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Nancy Pan
- Division of Pediatric Rheumatology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Julia G Harris
- Division of Pediatric Rheumatology, Children's Mercy Kansas City, Kansas City, MO, United States
| | - Andrew Warmin
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kendra Wiegand
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jon M Burnham
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Fatima Barbar-Smiley
- Division of Rheumatology, Nationwide Children's Hospital, Columbus, OH, United States
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