ABSTRACT
Objective To evaluate the short-term patient satisfaction, compliance, disease control and infection risk of telemedicine (TM) compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during COVID-19.Methods This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented.Results From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the 2 groups except a higher physician global assessment score (PGA) in the TM group. After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group. More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%; p = 0.049) with higher baseline PGA (OR = 1.15, 95% CI 1.07–1.23) being the independent predictor. The proportions of patients remained in LLDAS were similar in the 2 groups (TM: 75.0% vs SF: 74.2%, p = 0.919). None of the patients had COVID-19.Conclusion TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA.
Subject(s)
COVID-19ABSTRACT
Background: Telemedicine has become an essential tool to manage patients with chronic disease during the COVID-19 pandemic in many parts of the world, and its widespread use will likely go beyond the outbreak. However, there is no study examining the factors associated with telemedicine use for follow-up of patients with SLE. Methods: Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to telemedicine in the form of videoconferencing. The demographic, socioeconomic and disease data of the first 140 patients opted for telemedicine and 140 control patients preferred to continue standard in-person follow-up were compared. Results: The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90%). Three quarters of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) was 0.46 ± 0.62 and SLICC/ACR damage index was 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. It was found that patients with higher mean PGA (telemedicine: 0.54±0.63 vs control: 0.38±0.59, p=0.025) and family monthly income > USD3, 800 (telemedicine: 51/140, 36.4% vs control: 33/140, 23.6%; p=0.028) preferred telemedicine, while full-time employees (telemedicine: 56/140, 40.0% vs control: 71/140, 50.7%; p=0.041) preferred in-person follow-up. These predictors remained significant after controlling for age in the multivariate analysis. PGA was positively correlated with the perception that TM could reduce and routine visit could increase the risk of COVID-19 during the outbreak. No other clinical factors were found to be associated with the preference of telemedicine follow-up. Conclusions: When choosing the mode of care delivery between telemedicine and physical clinic visit for patients with SLE, the subjective disease activity as well as patient’s employment and economic status appeared to be important.