Tele-rheumatology: Outcomes from theCOVID-19 pandemic

ABSTRACT

Background/AimsThe COVID-19 pandemic resulted in significant disruption to outpatientservices, with hospital resources redirected to acute medical andcritical care units. Social distancing measures meant that routine faceto-face outpatient appointments needed to be cancelled or reimagined. Telemedicine offered an attractive solution. Telemedicine usestechnology to increase access to healthcare and has been usedinternationally in remote clinical settings, the National Health Service's'111' as well as in the National Aeronautics and Space Administration(NASA).MethodsThe University Hospital Lewisham Rheumatology Department organised outpatient review of new and follow-up patients via a consultantsupervised registrar telephone clinic 5 days a week during the firstwave of the COVID-19 pandemic. 278 patients had a telephoneconsultation with the registrar over a 3-month period (30 March to 30June 2020) 197 new and 81 follow-up patients.ResultsOf the 197 new patient referrals 2% required urgent face-to-facereview (new inflammatory arthritis);31% were provided with futureroutine clinic appointments and 44% were discharged 35 patientswithout the need for any further investigations and 52 patientsfollowing subsequent investigations (e.g. phlebotomy and radiology).Patients were provided with management advice, links to onlineresources and referred to allied health professionals as indicated, e.g.physiotherapy. Patients were effectively discharged following telephone consultation if the history was sufficient to exclude a conditionrequiring secondary care management and if relevant communityinvestigations were negative (including inflammatory markers andimmunology). 62 of the 197 newly referred patients were offered aroutine follow-up appointment. 36 of these patients were reviewed inperson when COVID-19 restrictions eased. Of these 36 patients, 20were subsequently discharged, diagnoses included chronic pain (5), osteoarthritis (3), mechanical joint pain (6). 11 patients remained forfollow up, diagnoses included Sjö gren's syndrome (2) and palindromicrheumatism (1). 5 patients did not attend.ConclusionThe strengths of this model were the ability to continue to provide anoutpatient rheumatology service;provide safe and effective management for new and follow-up patients;provide patient specific advicepertaining to COVID-19 and to support patients and primary careclinicians. The weaknesses of this model were the use of a singlepractitioner. Video consultation was not available when this model wasimplemented, but should add further to subsequent services. Our experience with the tele-rheumatology model suggests that atelephone triage system, coupled with relevant investigations prior toreferral could lead to an effective virtual management strategy withpotential beyond the COVID-19 pandemic. It also has great promisewith regards to managing chronic conditions in clinical remission withvideo or telephone consultations, utilising virtual disease activityscores (ePROMS now available via the BSR) and satellite monitoringof blood tests and urinalysis. As technology continues to advance, weshould explore ways to modernise the outpatient services.