The concept of telemedicine in pediatric rheumatology in Tunisia: Parents' perceptions.

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.

Telemedicine in Juvenile Idiopathic Arthritis in the era of COVID-19

Background With the COVID-19 pandemic, health care systems are facing challenges in delivering proper patient care. Children and adolescents with juvenile idiopathic arthritis (JIA) require specialized and comprehensive attention [1]. 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 structured phone interviews of parents' JIA patients. Sociodemographic data and disease characteristics (subtype of JIA, disease duration) were collected. We evaluated their point of view and suitability for telemedicine by inquiring about distance to go hospital, electronic devices, personal barriers to telemedicine, and reasons for adopting this alternative. Then, we compared sociodemographic outcomes between the two groups: telemedicine versus live consultation. Results The study included 23 parents. Nearly half of the patients (48%) had a monthly income ranging between 500 and 1000 dinars (183 and 367 dollars) and 26% of them had a monthly income less than 500 dinars (183 dollars). The mean travel time to reach hospital was less than 2 hours in 47% of cases, between 2 and 5 hours in 29% of cases and more than 5 hours in 24% of cases. Only 2 family members experienced severe covid-19 symptoms. Electronic devices afforded in the house were as follows: smartphone (30%), internet (44%), basic phones (4%) and all of the above (17%). Only three parents were aware of the concept of telemedicine and 39% of them would accept this model of care. The most preferred mean of telecommunication was video calls (70%) versus phone calls (30%). The main reasons for favoring telemedicine were avoiding hospitals during the pandemic (58%), cost saving (50%), time saving (42%) as well as avoiding school absenteeism (50%). The main reasons for preferring a live consultation were the fear of a possible discrepancy between physical and distant evaluation (56%), the fear of the trivialization of the disease (39%), concerns over the ability to operate the technology (17%) and finally, the fear of losing connectivity (11%). There was no association between preference for telemedicine and a higher income (p = 0.322), the duration of time to go to hospital (p = 0.154), as well as a family history of COVID-19 (p = 0.164). A significant association was found between those preferring a live consultation and the fear of trivializing the disease by their children (p = 0.031). However electronic devices did not seem an obstacle to telemedicine (p = 0.59). Conclusion Unlike the literature data, our study showed the low prevalence of parents willing to accept telemedicine as a model of care. This imply an urgent need for parent and patient education in order to promote telemedicine especially in pediatric rheumatology.