ABSTRACT
618 Table 2Factors associated with timely outpatient rheumatology follow-up RR 95% CI p-value Month of fol ow-up 0.99 [0.98 - 1.00] 0.09 Post-MOC 1.09 [0.93 - 1.28] 0.29 Age at visit 0.97 [0.94 – 1.00] 0.09 Male sex 0.92 [0.73 - 1.16] 0.49 Race/ethnicity Reference: Non-Hispanic White - Asian alone or in combination 1.20 [0.91 - 1.58] 0.19 Black alone or in combination 1.22 [0.92 - 1.62] 0.17 Hispanic White/Other 1.51 [1.15 - 1.99] 0.00 Non-Hispanic Other race 0.54 [0.28 - 1.02] 0.06 Social Vulnerability Index Lowest Medium Low 1.00 [0.75 - 1.33] 0.98 Medium High 0.94 [0.71 - 1.25] 0.68 Highest 1.03 [0.82 - 1.29] 0.82 Within 6 months of diagnosis at last visit 1.26 [1.05 - 1.53] 0.02 Prednisone use at last visit 1.17 [0.93 - 1.46] 0.17 SLEDAI score at last visit 1.02 [1.01 - 1.04] 0.01 Any DMARD use at last visit 1.52 [1.04 - 2.24] 0.03 History of synovitis 0.85 [0.70 - 1.05] 0.13 History of lupus nephritis 1.13 [0.95 - 1.35] 0.17 Estimates from modified robust Poisson models with subject-level random effects
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.
Subject(s)
Parents , Patient Acceptance of Health Care , Patient Satisfaction , Pediatrics , Rheumatic Diseases/therapy , Rheumatology , Telemedicine , Adolescent , Ambulatory Care , Arthritis, Juvenile , COVID-19 , Child , Child, Preschool , Female , Humans , Lupus Erythematosus, Systemic , Male , Musculoskeletal Pain , Rheumatic Diseases/diagnosis , SARS-CoV-2ABSTRACT
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.