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de la Torre Rubio N, Pavía Pascual M, Campos Esteban J, Godoy Tundidor H, Fernández Castro M, Andréu Sánchez JL. Usefulness of an electronic consultation system between primary care health centres and the rheumatology department of a tertiary hospital. REUMATOLOGIA CLINICA 2023; 19:512-514. [PMID: 37164881 DOI: 10.1016/j.reumae.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/13/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND AND OBJECTIVE Rheumatic diseases account for almost 30% of consultations attended in Spanish primary care centres. The main objective was to analyse the demand for rheumatology consultations from Primary Care and their resolution using the electronic consultation system. PATIENTS AND METHODS Retrospective descriptive study of electronic consultations from primary care centres in the health area to the Rheumatology service of a tertiary hospital, between July 2020 and May 2021. RESULTS The last 500 consecutive consultations were collected. Mean age of patients was 59.5 years; 74.2% were women. Main reasons for consultation were osteoporosis and treatment of patients with rheumatoid arthritis and spondyloarthritis under follow-up by the department. Mean response time was 2 days. Fifty-seven per cent of patients required outpatient appointments. DISCUSSION Over 40% of queries were resolved thanks to the electronic consultation system in an average of 2 days, otherwise patients would have been referred to specialized care.
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Affiliation(s)
- Natalia de la Torre Rubio
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain.
| | - Marina Pavía Pascual
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - José Campos Esteban
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Hilegarda Godoy Tundidor
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - Mónica Fernández Castro
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
| | - José Luis Andréu Sánchez
- Servicio de Reumatología del Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
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Nieto-González JC, Monteagudo I. Teleconsultation of infant rheumatology in Covid-19 time. REUMATOLOGIA CLINICA 2022; 18:379-380. [PMID: 35680369 PMCID: PMC8075809 DOI: 10.1016/j.reumae.2020.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
| | - Indalecio Monteagudo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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3
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Tornero-Molina J, Díez-Andrés ML, Alonso F, de la Llana-Calvo C, Luengo Rojo S, Casado Silvestre E, Grado Sanz R. Usefulness of rheumatology consultancy in situ: Analysis of a long-term experience. ACTA ACUST UNITED AC 2021; 18:480-485. [PMID: 34531168 DOI: 10.1016/j.reumae.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the long-term experience of a rheumatologist consultant "in situ" (RCI) in a primary care centre (PCC). MATERIAL AND METHODS Observational retrospective study analysing the complete cohort of the patients seen by the RCI between 2013 and 2019. Rheumatology patients' clinical characteristics and course of care were collected to estimate the diagnoses that were most likely to be monitored by a primary care physician (PCP). RESULTS A total of 876 consultations were attended; 205 were men (23.4%) and 671 women (76.6%).Most of the consultations (280, 33.2%) were diagnostic. On 167 occasions (19.8%) therapeutic issues were analysed; in 47 (5.6%) therapeutic infiltrations were performed. Chronic patient control was applied in 163 subjects (19.3%). A request for tests not available to the PCP was the reason for the consultation in 154 situations (18.3%). The profile most likely to continue being monitored in the PCC is the patient with osteoarthritis (OR = .13, CI 95%: .02-.67), soft tissue rheumatism (OR = .006, 95% CI: .01-.45) or cervical disc herniation (OR = .13, 95% CI: .02-.66). Less likely to be monitored by PCP after being seen by the RCI were subjects with rheumatoid arthritis (OR = .03, 95% CI: .00-.24), other inflammatory arthropathies (OR = .36, 95% CI: .16-.80) or with polymyalgia rheumatica (OR = .19, 95% CI: .06-.64 ), and those in need of chronic disease monitoring (OR = .16, 95% CI: .07-.34). CONCLUSIONS The RCI makes it easier for the PCP to monitor patients with osteoarthritis, soft tissue rheumatism and cervical disc pathology.
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Affiliation(s)
- Jesús Tornero-Molina
- Servicio de Reumatología, Hospital General Universitario de Guadalajara, Guadalajara, Spain; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, Spain.
| | | | - Fernando Alonso
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | | | - Susana Luengo Rojo
- Centro de Salud Pastrana, Gerencia de Atención Integrada, Guadalajara, Spain
| | | | - Raquel Grado Sanz
- Centro de Salud Cervantes, Gerencia de Atención Integrada, Guadalajara, Spain
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Tornero-Molina J, Díez-Andrés ML, Alonso F, de la Llana-Calvo C, Luengo Rojo S, Casado Silvestre E, Grado Sanz R. Usefulness of Rheumatology Consultancy in situ: Analysis of a Long-term Experience. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00159-5. [PMID: 34229962 DOI: 10.1016/j.reuma.2021.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To report the long-term experience of a rheumatologist consultant in situ (RCI) in a primary care centre (PCC). MATERIAL AND METHODS Observational retrospective study analysing the complete cohort of the patients seen by the RCI between 2013 and 2019. Rheumatology patients' clinical characteristics and course of care were collected to estimate the diagnoses that were most likely to be monitored by a primary care physician (PCP). RESULTS A total of 876 consultations were attended; 205 were men (23.4%) and 671 women (76.6%). Most of the consultations (280, 33.2%) were diagnostic. On 167 occasions (19.8%) therapeutic issues were analysed; in 47 (5.6%) therapeutic infiltrations were performed. Chronic patient control was applied in 163 subjects (19.3%). A request for tests not available to the PCP was the reason for the consultation in 154 situations (18.3%). The profile most likely to continue being monitored in the PCC is the patient with osteoarthritis (OR=0.13, CI 95%: 0.02-0.67), soft tissue rheumatism (OR=0.006, 95%CI: 0.01-0.45) or cervical disc herniation (OR=0.13, 95%CI: 0.02-0.66). Less likely to be monitored by PCP after being seen by the RCI were subjects with rheumatoid arthritis (OR=0.03, 95%CI: 0.00-0.24), other inflammatory arthropathies (OR=0.36, 95%CI: 0.16-0.80) or with polymyalgia rheumatica (OR=0.19, 95%CI: 0.06-0.64), and those in need of chronic disease monitoring (OR=0.16, 95%CI: 0.07-0.34). CONCLUSIONS The RCI makes it easier for the PCP to monitor patients with osteoarthritis, soft tissue rheumatism and cervical disc pathology.
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Affiliation(s)
- Jesús Tornero-Molina
- Servicio de Reumatología, Hospital General Universitario de Guadalajara, Guadalajara, España; Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá de Henares, Alcalá de Henares, España.
| | | | - Fernando Alonso
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Susana Luengo Rojo
- Centro de Salud Pastrana, Gerencia de Atención Integrada, Guadalajara, España
| | | | - Raquel Grado Sanz
- Centro de Salud Cervantes, Gerencia de Atención Integrada, Guadalajara, España
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5
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[Virtual consultations in Traumatology and Orthopaedic Surgery]. Semergen 2021; 47:305-314. [PMID: 34112593 DOI: 10.1016/j.semerg.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 01/30/2021] [Accepted: 03/17/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The objective of this study is to analyse the current system of virtual consultations between the levels of Primary and Specialised Care in the field of Traumatology and Orthopaedic Surgery (TOS) in our healthcare area. MATERIAL AND METHOD A retrospective observational study was carried out on 90 consecutive patients who had a non-face-to-face consultation between 3 January 2017 and 10 February 2017 and subsequently a face-to-face consultation. All the patients belonged to the same healthcare area attached to the Nuestra Señora de Candelaria University Hospital. The data on the diagnostic orientation, medical history provided and complementary tests were evaluated by 2 observers, one with training in Family and Community Medicine and the other with specialised training in TOS, and compared with those obtained in the final face-to-face assessment. RESULTS The results showed a low inter-judge agreement regarding the diagnostic orientation, anamnesis, exploration and complementary tests provided in the virtual consultation request. It was considered that only 59% for one observer (Family and Community Medicine) and 47.7% for the other (specialised care) had sufficient information for decision-making. Furthermore, 35.2% required more than one face-to-face assessment consultation until diagnosis and in 45.5% it was necessary to request new complementary tests. In 30.7%, there was no concordance in the suggested and final diagnosis. In 51.9%, no therapeutic action other than that carried out by Primary Care was carried out and 34.1% of the patients were referred to the Rehabilitation department. CONCLUSIONS The current model of virtual consultations in TOS does not seem adequate to respond to this new healthcare model. The number of unnecessary referrals is very high despite the previous virtual assessment by a specialist in TOS. The Family and Community Medicine specialist should have more diagnostic resources and coordination between Primary and Specialised Care is necessary to determine, in the area of TOS, the type of consultations and conditions for which this system should be implemented to obtain adequate coordination and improve communication between both levels of care.
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Jover R, Clofent J, de Vera F, López-Serrano A, Gutiérrez A, Aguas M, Nos P. Recommendations of the Valencian Society of Digestive Pathology for the use of telemedicine and non-contact consultations. GASTROENTEROLOGIA Y HEPATOLOGIA 2021; 45:299-303. [PMID: 34051311 PMCID: PMC8152203 DOI: 10.1016/j.gastrohep.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/28/2021] [Accepted: 04/13/2021] [Indexed: 10/25/2022]
Abstract
The COVID-19 pandemic has meant a qualitative change in the way patients are treated in outpatient clinics. The need to take measures of social isolation as prevention for contagion by the new coronavirus has forced the use of telematic and telephone consultations in most medical and surgical units. The specialty of digestive medicine, due to the characteristics of its patients and frequent support in complementary techniques for diagnosis, is especially suitable for the use of non-contact consultations. In this document a series of recommendations are proposed that can serve as a guide for the establishment or improvement of non-face-to-face digestive medicine consultations.
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Affiliation(s)
- Rodrigo Jover
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica ISABIAL, Alicante, España.
| | | | - Félix de Vera
- Sección de Medicina Digestiva, Hospital General de Elda, Elda (Alicante)
| | | | - Ana Gutiérrez
- Servicio de Medicina Digestiva, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica ISABIAL, Alicante, España; CIBERehd, Centro de Investigación Biomédica en Red, Instituto de Salud Carlos III
| | - Mariam Aguas
- Servicio de Medicina Digestiva, Hospital La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
| | - Pilar Nos
- Servicio de Medicina Digestiva, Hospital La Fe, Instituto de Investigación Sanitaria La Fe, Valencia, España
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Nieto-González JC, Monteagudo I. Teleconsultation of Infant Rheumatology in Covid-19 Time. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30233-3. [PMID: 33139179 PMCID: PMC7543887 DOI: 10.1016/j.reuma.2020.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 09/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Indalecio Monteagudo
- Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Madrid, España
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Sumpton D, Hannan E, Kelly A, Tunnicliffe D, Ming A, Hassett G, Craig JC, Tong A. Clinicians' perspectives of shared care of psoriatic arthritis and psoriasis between rheumatology and dermatology: an interview study. Clin Rheumatol 2020; 40:1369-1380. [PMID: 32935247 DOI: 10.1007/s10067-020-05391-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/26/2020] [Accepted: 09/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Shared care between rheumatologists and dermatologists is advocated for patients with psoriasis and psoriatic arthritis, but care provided by rheumatologists and dermatologists is often siloed, leading to inconsistencies in patient care and outcomes. This study aimed to describe rheumatologists' and dermatologists' perspectives on shared care. METHODS Face-to-face semi-structured interviews were conducted with 15 rheumatologists and 12 dermatologists across 27 centers in Australia. Transcripts were thematically analyzed. RESULTS Five themes were identified: uncertainties in disciplinary tensions (lacking expertise to make diagnosis, hesitation managing outside of scope, doubting screening tools, defaulting to own disciplinary priorities, hampered by lack of evidence), working in fragmented care (frustration with working in silos, striving to coordinate with primary care, persevering despite inequities in access to care, overwhelmed by managing comorbidities, under-resourced for complexity), building trusting relationships (establishing a culture of collaboration, seeking reliable cross-specialty help, depending on unique skills), prioritizing efficiency (minimizing burden for patients, avoiding resource overuse, deferring to pragmatic decisions), and strengthened by integrated care models (improving the timeliness and accuracy of care, centering on patient goals and understanding, enhancing cross-specialty partnerships, providing opportunities for education and training). CONCLUSIONS Rheumatologists and dermatologists endeavor to provide comprehensive care to their patients in disjointed healthcare settings but are hampered by a lack of training and a sense of feeling overburdened in the management of comorbidities. Interdisciplinary models are perceived to improve the care of patients but are limited by financial barriers to implementation and concerns about wasting health resources and improperly burdening patients. Key Points • Rheumatologists and dermatologists perceive that shared care models improve the care for their patients with psoriatic arthritis and psoriasis by improving the timeliness and accuracy of management, making the patient the center of care, and enhancing shared care relationships between specialties. • Screening tools to detect psoriatic arthritis may be under-utilized by dermatologists due to doubt about the accuracy of instruments and competing priorities in time-limited consultations. • Management of comorbid disease is challenging for rheumatologists and dermatologists due to a need to prioritize their specialty area and a sense of feeling overburdened while working in fragmented healthcare systems.
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Affiliation(s)
- Daniel Sumpton
- Department of Rheumatology, Concord Repatriation General Hospital, Sydney, NSW, Australia. .,The University of Sydney School of Public Health, Sydney, NSW, Australia. .,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia.
| | - Elyssa Hannan
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Ayano Kelly
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia.,Australian National University, Canberra, ACT, Australia.,Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia
| | - David Tunnicliffe
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Andrew Ming
- Department of Dermatology, The Children's Hospital Westmead, Sydney, NSW, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Sydney, NSW, Australia.,South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia.,Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Allison Tong
- The University of Sydney School of Public Health, Sydney, NSW, Australia.,Centre for Kidney Research, The Children's Hospital Westmead, Sydney, NSW, Australia
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Organisational and Clinical Approach to Osteoporosis in Rheumatology: OP-SER-Excellence Survey and Consensus. ACTA ACUST UNITED AC 2019; 17:322-328. [PMID: 31826829 DOI: 10.1016/j.reuma.2019.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 10/27/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine and analyse the organisational approach adopted by Spanish rheumatologists to osteoporosis (OP) to define strategic priorities. MATERIAL AND METHOD A group of experts designed a questionnaire on OP in the rheumatologist practice. The survey was sent to the Spanish Society of Rheumatology (SER) members. Through the Delphi round, strategic priorities were agreed upon in OP. RESULTS The priorities are: 1) The SER should promote the inclusion of OP in 100% of the services and expand the training offer; 2) Rheumatology services should promote the role of the nurse in OP, promote quality indicators and referral protocols agreed with primary care in addition to promoting their training in this area; 3) The SER and Rheumatology services should promote electronic consultation, OP monographic clinics and participation in Fracture Liaison Service units. CONCLUSIONS Strategic priorities in OP help identify areas of improvement at organisational, structural and quality standards level in this pathology.
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Liddy C, Moroz I, Mihan A, Nawar N, Keely E. A Systematic Review of Asynchronous, Provider-to-Provider, Electronic Consultation Services to Improve Access to Specialty Care Available Worldwide. Telemed J E Health 2019; 25:184-198. [DOI: 10.1089/tmj.2018.0005] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Clare Liddy
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Isabella Moroz
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Ariana Mihan
- C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Canada
| | - Nikhat Nawar
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Erin Keely
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Canada
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Piga M, Cangemi I, Mathieu A, Cauli A. Telemedicine for patients with rheumatic diseases: Systematic review and proposal for research agenda. Semin Arthritis Rheum 2017; 47:121-128. [PMID: 28420491 DOI: 10.1016/j.semarthrit.2017.03.014] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 03/17/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review the scientific literature regarding tele-rheumatology and draw conclusions about feasibility, effectiveness, and patient satisfaction. METHODS PubMed, Scopus, and Cochrane database searches were performed (April 2016) using relevant MeSH and keyword terms for telemedicine and rheumatic diseases. Articles were selected if reporting outcomes for feasibility, effectiveness, and patient satisfaction and methodologically appraised using the Cochrane Collaboration's tool for assessing risk of bias and a modified version of CONSORT 2010 Statement. RESULTS A total of 177 articles were screened, 23 were selected for the present review but only 9 were RCTs. Five studies reported on feasibility, 14 effectiveness, and 9 satisfaction rates for different tele-rheumatology interventions grouped in synchronous (remotely delivered consultation) and asynchronous (remote disease activity assessment; tele-monitoring of treatment strategies or rehabilitation; and remotely delivered self-management programs). Seven studies (30.4%) were on rheumatoid arthritis, 2 (8.7%) were on systemic sclerosis (1 including also rheumatoid arthritis patients), 5 (21.7%) on fibromyalgia, 2 (8.7%) on osteoarthritis, 3 (13.0%) on juvenile idiopathic arthritis and 4 (17.4%) on mixed disease cohorts. Interventions and outcomes heterogeneity prevented meta-analysis of results. Overall, feasibility and patient satisfaction rates were high or very high across intervention types. Effectiveness was equal or higher than standard face-to-face approach in controlled trials which, however, were affected by small sample size and lack of blinding participants according to appraisal tools. CONCLUSION Telemedicine may provide a well-accepted way to remotely deliver consultation, treatment and monitoring disease activity in rheumatology. Higher quality RCTs demonstrating effectiveness of different tele-rheumatology interventions are needed.
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Affiliation(s)
- Matteo Piga
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy.
| | - Ignazio Cangemi
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alessandro Mathieu
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
| | - Alberto Cauli
- Chair of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, SS 554-09 042 Monserrato, Cagliari, Italy
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Caffery LJ, Farjian M, Smith AC. Telehealth interventions for reducing waiting lists and waiting times for specialist outpatient services: A scoping review. J Telemed Telecare 2016; 22:504-512. [PMID: 27686648 DOI: 10.1177/1357633x16670495] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Accepted: 08/30/2016] [Indexed: 12/21/2022]
Abstract
We undertook a scoping review of the published literature to identify and summarise key findings on the telehealth interventions that influence waiting times or waiting lists for specialist outpatient services. Searches were conducted to identify relevant articles. Articles were included if the telehealth intervention restructured or made the referral process more efficient. We excluded studies that simply increased capacity. Two categories of interventions were identified - electronic consultations and image-based triage. Electronic consultations are asynchronous, text-based provider-to-provider consultations. Electronic consultations have been reported to obviate the need for face-to-face appointments between the patient and the specialist in between 34-92% of cases. However, it is often reported that electronic consultations are appropriate in less than 10% of referrals for outpatient care. Image-based triage has been used successfully to reduce unnecessary or inappropriate referrals and was used most often in dermatology, ophthalmology and otolaryngology (ENT). Reported reduction rates for face-to-face appointments by specialty were: dermatology 38-88%, ophthalmology 16-48% and ENT 89%. Image-based triage can be twice as effective as non-image based triage in reducing unnecessary appointments. Telehealth interventions can effectively be used to reduce waiting lists and improve the coordination of specialist services, and should be considered in conjunction with clinical requirements.
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Affiliation(s)
- Liam J Caffery
- Centre for Online Health, The University of Queensland, Australia
| | | | - Anthony C Smith
- Centre for Online Health, The University of Queensland, Australia
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13
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Ward IM, Schmidt TW, Lappan C, Battafarano DF. How Critical is Tele-Medicine to the Rheumatology Workforce? Arthritis Care Res (Hoboken) 2016; 68:1387-9. [PMID: 26866514 DOI: 10.1002/acr.22853] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/26/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Ian M Ward
- San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas
| | - Thomas W Schmidt
- San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas
| | - Charles Lappan
- Telehealth, Regional Health Command, Central (Provisional), Fort Sam Houston, Texas
| | - Daniel F Battafarano
- San Antonio Uniformed Services Health Education Consortium, Fort Sam Houston, Texas
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Nolla JM, Martínez C, García-Vicuña R, Seoane-Mato D, Rosario Lozano MP, Alonso A, Alperi M, Barbazán C, Calvo J, Delgado C, Fernández-Nebro A, Mateo L, Pérez Sandoval T, Pérez Venegas J, Rodríguez Lozano C, Rosas J. Quality standards for rheumatology outpatient clinic. The EXTRELLA project. ACTA ACUST UNITED AC 2016; 12:248-55. [PMID: 26775226 DOI: 10.1016/j.reuma.2015.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/02/2015] [Accepted: 11/06/2015] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In recent years, outpatient clinics have undergone extensive development. At present, patients with rheumatic diseases are mainly assisted in this area. However, the quality standards of care are poorly documented. OBJECTIVE To develop specific quality criteria and standards for an outpatient rheumatology clinic. METHOD The project was based on the two-round Delphi method. The following groups of participants took part: scientific committee (13 rheumatologists), five nominal groups (45 rheumatologists and 12 nurses) and a group of discussion formed by 9 patients. Different drafts were consecutively generated until a final document was obtained that included the standards that received a punctuation equal or over 7 in at least 70% of the participants. RESULTS 148 standards were developed, grouped into the following 9 dimensions: a) structure (22), b) clinical activity and relationship with the patients (34), c) planning (7), d) levels of priority (5), e) relations with primary care physicians, with Emergency Department and with other clinical departments, f) process (26), g) nursing (13), h) teaching and research (13) and i) activity measures (8). CONCLUSION This study established specific quality standards for rheumatology outpatient clinic. It can be a useful tool for organising this area in the Rheumatology Department and as a reference when proposing improvement measures to health administrators.
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Affiliation(s)
- Joan M Nolla
- Servicio de Reumatología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - Carmen Martínez
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Alberto Alonso
- Servicio de Reumatología, Hospital Universitario de Cruces, Baracaldo, Vizcaya, España
| | - Mercedes Alperi
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, España
| | - Ceferino Barbazán
- Servicio de Reumatología, Complexo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España
| | - Jaime Calvo
- Servicio de Reumatología, Hospital Sierrallana, Torrelavega, Cantabria, España
| | - Concepción Delgado
- Servicio de Reumatología, Hospital Clínco Universitario Lozano Blesa, Zaragoza, España
| | | | - Lourdes Mateo
- Servicio de Reumatología, Hospital Universitari Germans Trías i Pujol, Badalona, Barcelona, España
| | | | - José Pérez Venegas
- Servicio de Reumatología, Hospital de Jerez de la Frontera, Jerez de la Frontera, Cádiz, España
| | - Carlos Rodríguez Lozano
- Servicio de Reumatología, Hospital Universitario Dr. Negrín, Las Palmas de Gran Canaria, España
| | - José Rosas
- Servicio de Reumatología, Hospital de la Marina Baixa, Villajoyosa, Alicante, España
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15
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Analysis of information on rheumatology from a selected Internet forum in the context of the need for telemedicine solutions. Reumatologia 2015; 53:260-7. [PMID: 27407257 PMCID: PMC4847316 DOI: 10.5114/reum.2015.55829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 11/04/2015] [Indexed: 12/02/2022] Open
Abstract
Objectives The aim of this study was to determine how often patients and undiagnosed people who complain of musculoskeletal system and rheumatic diseases look for knowledge contained on an Internet forum. Content analysis was used to identify the level of Internet users’ activity in the rheumatology section, compared to other areas of medicine. Material and methods Material included information posted on the Internet forum established at http://medyczka.pl/. The method employed was a quantitative and qualitative analysis of the content. The method was based on qualitative assessment of the first post in each thread presented on the rheumatologic subforum, by assigning keywords, subjectively determined by the researcher, to such a post. For each keyword a specific definition was established, determining a situation in which a given keyword was used. Results The quantitative analysis qualified rheumatology in the last place in terms of Internet users’ activity compared to other branches of medicine. The qualitative assessment of the rheumatologic forum indicated that the three most common keywords were joint pain (32), joints swelling (13), and schoolage (13). The three most common intentional keywords (arranged in order of their decreasing number) were diagnosis based on symptoms (29), interpretation of the laboratory test results (9), and how to deal with symptoms (8). Conclusions The analysis leads to the conclusion that the rheumatologic subforum, along with other subforums listed above, presents a critically low level of discussion. There is a large disproportion between the number of active and passive forum users, suggesting that numerous individuals search the forum for presented information. Based on the qualitative analysis of the information stocks of the rheumatologic subforum, it was established that most of the questions posted concerned young individuals, who complained of joint pain and swelling, and asked for a possible diagnosis based on the presented symptomatology, interpretation of the laboratory test results and alleviation of disease symptoms.
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16
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Correll CK, Spector LG, Zhang L, Binstadt BA, Vehe RK. Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States. Pediatr Rheumatol Online J 2015; 13:32. [PMID: 26215389 PMCID: PMC4517495 DOI: 10.1186/s12969-015-0028-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Access to pediatric rheumatology (PR) care is limited, however the impact that limited access to PR has on pediatricians has not been examined. The goal of this study was to investigate barriers to PR referrals and resulting alternative referral patterns among primary pediatricians. METHODS A web-based survey was emailed to primary pediatricians practicing in Minnesota, North Dakota, and South Dakota in order to investigate access to PR care issues. Basic descriptive analysis was performed. RESULTS The response rate was 15 % (93/609). Twenty-nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9 % (8/92) were more than six hours away. Ninety-two percent (85/92) had referred a patient to PR at least once, but 89 % (83/93) had experienced a situation in which they considered a referral to PR but ultimately did not. Many had referred to other subspecialists instead: 29 % (24/83) to pediatric infectious disease, 20 % to adult rheumatology, and 12 % to pediatric orthopedics, while 34 % managed the patient themselves. Thirty-five percent (32/60) had referred to an adult rheumatologist, commonly due to decreased travel (44 %), while physician preference was never selected as a reason. CONCLUSION Pediatricians often refer children with possible rheumatic disease to specialists other than PR mainly due to long travel distances. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to PR care.
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Affiliation(s)
- Colleen K. Correll
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
| | - Logan G. Spector
- Division of Epidemiology and Clinical Research, Department of Pediatrics, University of Minnesota, Minneapolis, MN USA ,University of Minnesota Masonic Cancer Center, Minneapolis, MN USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Bryce A. Binstadt
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
| | - Richard K. Vehe
- Division of Rheumatology, Department of Pediatrics, University of Minnesota, East Bldg Rm M668 2450 Riverside Ave, Minneapolis, MN USA
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