Exploring Pediatric Tele-Rheumatology Practices During COVID-19: A Survey of the PRCOIN Network

Abstract

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.

APLAR recommendations on the practice of telemedicine in rheumatology

“…Nevertheless, the current literature identified some barriers to the acceptability and sustainability of telerheumatology, such as limited access to technology, absence of laboratory testing or physical examination, loss of travel‐related or sick‐leave benefits, and concerns about data privacy 9‐13 …”

“…In contrast to patients with established diagnoses, there were no studies that directly compared teleconsultation and in‐person visits in people without confirmed rheumatologic conditions (ie, “new” patients), possibly because most trials excluded these new patients for safety purposes. In a survey of the Pediatric Rheumatology Care and Outcomes Improvement Network (PR‐COIN), 19 lead representatives reported that during the COVID‐19 pandemic, both new referrals and established patients were seen via teleconsultation in their respective centers, and the majority of centers (79%) felt telemedicine could be safely used for new patients 9 . However, an Australian retrospective case‐control study showed that after implementation of telemedicine, the odds of making an accurate diagnosis in new patients were reduced (28.6% vs 57.4%; odds ratio 0.30; 95% confidence interval: 0.16–0.53; P < .001) 22 .…”

Future challenges in rheumatology – is telemedicine the solution?

“… 73 Other challenges may include a limited ability to perform physical examinations and varying access to technology. 68 , 74 …”

Physical Health of Food Consumers during the COVID-19 Pandemic

“…Thus, maintaining regular levels of physical activity can be a challenge for most people, who saw the places where they used to exercise, closed (such as gyms, parks, sports associations, amongst others), due to the isolation measures and social distancing imposed by various governments around the world (Dwyer et al 2020;Goh et al 2021). There was a need to change the form and location where people exercised, with exercise being recommended at home, often using online classes with personal trainers or the use of exercise videos that focus on motivating and offering physical activity, or through the internet and mobile devices to maintain physical activity and physical health in this critical period (Amekran and El Hangouche 2021;Chen et al 2020).…”