ABSTRACT
Background: The COVID-19 public health emergency has amplifed both the potential value and the challenges with healthcare providers deploying telehealth solutions. Furthermore, outpatients may wait up to several months for their frst appointment with specialists including rheumatologists for diseases other than COVID-19. In Italy it is now possible to get access to telemedicine services within the national healthcare systems, yet only follow-up visits are allowed for reimbursement purposes. Instead, it is not clear the role of telemedicine as a tool for improving frst access and patient acceptance of this innovation. Objectives: To investigate the feasibility of a 'teletriagerheum' service before the frst visit and to identify potential benefts and disadvantages of it by comparing frst face-to-face visit preceded by 'teletriagerheum' service to regular frst visit without it. Methods: A pilot prospective monocentric study was conducted. Consecutive patients were contacted by phone 30 days before the scheduled rheu-matological frst visit by administrative staff to investigate their willingness to receive 20 days before the frst visit a phone call ('teletriagerheum' service) by a physician of the Rheumatology Unit. The 'teletriagerheum' service aimed at investigating the reason for the visit and at prescribing additional exams or specialistic consultations before the face-to-face frst visit to facilitate the diagnosis process or anticipate the appointment in case of urgency. Socio-demographic characteristics, reason for referral, face-to-face visit duration, number of additional exams prescribed, number of defnite diagnosis at frst visit in the 'teletriagerheum' group were compared to the ones receiving regular frst visit without 'teletriagerheum' service. Results: In October 2021 a total of 102 patients were phone called by administrative staff: 18 (17.6%) did not answer for a maximum of three times, 9 (8.8%) responded but refused the 'teletriagerheum' service (6 cancelled the visit, 1 postponed, 2 for unknown reason) and 75 (73.5%) accepted the service, but 21 were not real first visits and 8 patients did not answer the call of physician. Among the remaining 46 (45.1%) pts (the 'teletriagerheum' group) the median call time was 11.5 minutes (IQR 5-15 min), blood exams were prescribed to 34 (74%) and instrumental exams to 8 (17.4%). Further consultation was prescribed only to 1 patient and the visit was not anticipated in any case. A preliminary diagnosis was possible in 36 (78.2%). In most of the cases (33, 76%) no difficulties were reported by the physician, in 7 (16.3%) there were difficulties in communication, in 1 (2.3%) difficulty to get the history from a patient suffering from a psychiatric disorder. Socio-de-mographic characteristics, Information and communication technologies skills, face-to-face visit duration were not statistically different between the 'teletriagerheum' group (46 pts) and the group receiving regular first visit without 'teletriagerheum' service (52 pts). In the 'teletriagerheum' group, a lower number of blood exams (14% vs 46%, p<0.005) and a lower number of instrumental exams (25% vs 45%, p=0.04) were prescribed during the face-to-face frst visit;a higher percentage of defnitive diagnosis (79% vs 67%, whilst not statistically signifcant p=0.2) and a lower number of patients requiring a visit before 6 months (26% vs 54%, p<0.05) were observed compared to the group without teletriagerheum service. Conclusion: These preliminary data showed that telemedicine for the frst rheu-matological visit was well-accepted by patients searching for rheumatology consultations and had the potential to be a tool for improving clinical diagnosis and rheumatological follow up in everyday clinical practice. A larger cohort will let us to further explore the potential benefts of telemedicine to improve accessibility to rheumatological services.
ABSTRACT
The adverse effects of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are not limited to the related infectious disease. In children and adolescents, serious risks due to the coronavirus disease 2019 (COVID-19) pandemic are also related to its indirect effects. These include an unbalanced diet with an increased risk of weight excess or nutritional deficiencies, increased sedentary lifestyle, lack of schooling, social isolation, and impaired mental health.Pediatricians should be aware of the side effects of the COVID-19 pandemic on children's diet, physical mental health and advise the families according to their nutritional needs and financial resources. Moreover, the lack of a targeted therapy able to offer protection against the deleterious effects of SARS-CoV-2 infection should require a greater effort by scientific societies to find a more effective prevention strategy. In this context, much interest should be given to nutritional support, able to contrast malnutrition and to stimulate the immune system.