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Migowa AN, Hamdi W, Hashad S, Etayari H, Abushhaiwia A, Ferjani H, Nessib DB, Kharrat L, Fazaa A, Owino L, Faleye A, Owusu SA, Mosa DM, Eissa M, Nasef SI, Elsehrawy GG, Odhiambo R, Orwa J, Abu-Zaid MH. Development of the paediatric society of the African league against rheumatism (PAFLAR) JIA registry and clinical profile of JIA in Africa from the PAFLAR JIA registry. Pediatr Rheumatol Online J 2024; 22:67. [PMID: 39039515 PMCID: PMC11264440 DOI: 10.1186/s12969-024-01000-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 06/21/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND The spectrum of Juvenile Idiopathic Arthritis (JIA) in Africa is still largely unknown. We thus set out to illustrate how we set up the PAFLAR JIA registry and describe the clinical profile of Juvenile Idiopathic Arthritis across various regions in Africa. METHODS We carried out a retrospective observational cohort study where collaborators were trained on use of the existing PAFLAR REDCAP database to enter data for the JIA patients currently under their care capturing their epidemiological data, clinical features, laboratory investigations, diagnosis and therapy at initial diagnosis. Descriptive statistics including means, standard deviations, medians, interquartile ranges (IQR) for continuous variables and proportions for categorical variables were calculated as appropriate. Tests for difference between groups were performed between categorical variables using Pearson's chi-square or Fisher's exact tests. All analyses were performed using SPSS version 22 software. RESULTS We enrolled 302 patients, 58.6% (177 of 302) of whom were female. The median age of disease onset was 7 years (range 3-11 years) and the median age at diagnosis was 8.5 years (range 5-12 years). The median duration delay in diagnosis was 6 months (range 1-20.8 months). The JIA categories included Systemic JIA 18.9% (57), Oligoarticular JIA 19.2% (83), Polyarticular RF + ve 5% (15), Polyarticular RF-ve 17.9% (54), Enthesitis Related Arthritis (ERA) 18.2% (55), Psoriatic Arthritis 7% (21) and undifferentiated JIA 5.6% (17). As regards treatment the commonest therapies were NSAID therapy at 31.1%, synthetic DMARDs at 18.1%, synthetic DMARDs combined with NSAIDs at 17.5% and steroid therapy at 9.6%. Biological DMARDs accounted for 2.3% of therapies offered to our patients at diagnosis. The average JADAS score was 10.3 (range 4.8-18.2) and the average CHAQ score was 1.3 (range 0.7-2.0). CONCLUSION Our study highlights strategies involved in setting up a Pan-African paediatric rheumatology registry that embraces our broad diversity and the vast spectrum of JIA in Africa while comparing the various therapies available to our patients. The PAFLAR JIA registry strives to ensure a comprehensive representation of the diverse healthcare landscapes within the continent. Further longitudinal observation studies are required to ascertain the long-term outcomes of our patients and ultimately help inform policy to create a more favorable health ecosystem to support the healthcare needs of JIA patients in Africa.
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Affiliation(s)
- Angela Nyangore Migowa
- Department of Paediatrics, Aga Khan University Medical College East Africa Nairobi, P.O Box 30270, Nairobi, 00100, Kenya.
| | - Wafa Hamdi
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Soad Hashad
- Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya
| | - Hala Etayari
- Tripoli Children's Hospital, University of Tripoli, Tripoli, Libya
| | | | - Hanene Ferjani
- Rheumatology Department, Kassab Institute of Orthopedics, Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Dorra Ben Nessib
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Lobna Kharrat
- Department of Rheumatology, Kassab Institute - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Alia Fazaa
- Department of Rheumatology, Mongi Slim Hospital - Tunis El Manar University - Faculty of Medicine of Tunis, Tunis, Tunisia
| | - Lawrence Owino
- Department of Paediatrics, Faculty of Health Sciences Nairobi, University of Nairobi, Nairobi, Kenya
| | - Ayodele Faleye
- Department of Paediatrics, Lagos State University Teaching Hospital Lagos, Lagos, Nigeria
| | - Sheila Agyeiwaa Owusu
- Department of Paediatrics and Child Health, University for Development Studies, Tamale, Ghana
| | - Doaa Mosad Mosa
- Department of Rheumatology and Rehabilitation, Faculty of Medicine, Mansoura University Hospital, Mansoura, Egypt
| | - Mervat Eissa
- Department of Rheumatology, Cairo University, Cairo, Egypt
| | | | | | - Rachel Odhiambo
- Research Unit, Aga Khan University Medical College East Africa Nairobi, Nairobi, Kenya
| | - James Orwa
- Department of Population Health, Aga Khan University Medical College East Africa Nairobi, Nairobi, Kenya
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Margaretten ME, Yazdany J, Mandal J. Rheum at the Table for Everyone: A Call to Expand Rheumatology Knowledge for Primary Care Providers. Arthritis Rheumatol 2024; 76:993-995. [PMID: 38221722 DOI: 10.1002/art.42800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 01/16/2024]
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Pfeil A, Klemm P, Hueber AJ, Hoffmann T, Weise T, Oelzner P, Knop S, Müller-Ladner U, Lange U, Wolf G, Schett G, Simon D, Kleyer A. Enhancing student understanding of rheumatic disease pathologies through augmented reality: findings from a multicentre trial. Rheumatology (Oxford) 2024; 63:1949-1956. [PMID: 37740288 DOI: 10.1093/rheumatology/kead508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 09/02/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVE The possibility of combining real and virtual environments is driving the increased use of augmented reality (AR) in education, including medical training. The aim of this multicentre study was to evaluate the students' perspective on the AR-based Rheumality GO!® app as a new teaching concept, presenting six real anonymized patient cases with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). METHODS The study encompassed 347 undergraduate medical students (232 women and 115 men) from four medical universities in Germany (Jena, Bad Nauheim/Gießen, Nuremberg, Erlangen). The course was divided into a theoretical refresher lecture followed by six AR-based cases in each of the three indications presented in the Rheumality GO! app. All participants evaluated the course after completion, assessing the benefit of the app from a student's perspective using a questionnaire with 16 questions covering six subject areas. RESULTS The use of the AR-based app Rheumality GO! improved the understanding of pathologies in RA, PsA and axSpA for 99% of the participants. For 98% of respondents, the concept of AR with real patient data has made a positive impact on the teaching environment. On the other hand, 82% were in favour of the use of virtual tools (e.g. AR) in addition to this conventional approach. CONCLUSION The results of our survey showed that from the medical students' perspective, an AR-based concept like the Rheumality GO! app can complement rheumatology teaching in medical school as an effective and attractive tool though not replace bedside teaching.
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Affiliation(s)
- Alexander Pfeil
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Philipp Klemm
- Department of Rheumatology, Immunology, Osteology and Physical Medicine, Campus Kerckhoff, Justus-Liebig University Gießen, Bad Nauheim, Germany
| | - Axel J Hueber
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Tobias Hoffmann
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | | | - Peter Oelzner
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Stefan Knop
- Department Internal Medicine 5, Hemato-Oncology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ulf Müller-Ladner
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Uwe Lange
- Department Internal Medicine 5, Division of Rheumatology, Klinikum Nuremberg, Paracelsus Medical University, Nuremberg, Germany
| | - Gunter Wolf
- Department of Internal Medicine III, Jena University Hospital-Friedrich Schiller University Jena, Jena, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Rheumatology and Immunology, University Hospital Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Universitätsklinikum Erlangen und Friedrich-Alexander Universität Erlangen Nürnberg, Erlangen, Germany
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Curtis JR, Bykerk VP, Crow MK, Danila MI, Haraoui B, Karpouzas GA, Newman ED, Norton H, Peterson J, Thorne C, Wright GC, Bain L. Identification of Gaps in Quality of Care and Good Practice Interventions in Rheumatoid Arthritis: Insights From a Literature Review and Qualitative Study of Nine Centers in North America. ACR Open Rheumatol 2024. [PMID: 38937104 DOI: 10.1002/acr2.11695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE Quality of care (QoC) delivery in rheumatoid arthritis (RA) continues to suffer from various challenges (eg, delay in diagnosis and referral) that can lead to poor patient outcomes. This study aimed to identify good practice interventions that address these challenges in RA care in North America. METHODS The study was conducted in three steps: (1) literature review of existing publications and guidelines (April 2005 to April 2021) on QoC in RA; (2) in-person visits to >50 individual specialists and health care professionals across nine rheumatology centers in the United States and Canada to identify challenges in RA care and any corresponding good practice interventions; and (3) collation and organization of findings of the two previous methods by commonalities to identify key good practice interventions, followed by further review by RA experts to ensure key challenges and gaps in RA care were captured. RESULTS Several challenges and eight good practice interventions were identified in RA care. The interventions were prioritized based on the perceived positive impact on the challenges in care and ease of implementation. High-priority interventions included the use of technology to improve care, streamlining specialist treatment, and facilitating comorbidity assessment and care. Other interventions included enabling patient access to optimal medication regimens and improving patient self-management strategies. CONCLUSION Learnings from the study can be implemented in other rheumatology centers throughout North America to improve RA care. Although the study was completed before the COVID-19 pandemic, the findings remain relevant.
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Affiliation(s)
| | | | - Mary K Crow
- Hospital for Special Surgery, New York, New York
| | - Maria I Danila
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Boulos Haraoui
- Institut de Rhumatologie de Montréal, Montreal, Quebec, Canada
| | - George A Karpouzas
- Harbor-University of California, Los Angeles, Medical Center, Torrance, California
| | - Eric D Newman
- Geisinger, Danville, Pennsylvania, United States, ELAN Consulting Company, Danville, Pennsylvania, United States
| | | | - Jeff Peterson
- Western Washington Medical Group, Everett, Washington
| | - Carter Thorne
- Centre of Arthritis Excellence and The Arthritis Program Research Group, Newmarket, Ontario, Canada
| | | | - Lorna Bain
- Southlake Regional Health Centre, Newmarket, Ontario, Canada (current affiliation: Unity Health Toronto, Toronto, Ontario, Canada)
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Jaros BD, Gad I, Bolster MB, Dua AB. Addressing the Rheumatology Workforce Shortage: Clinician Educators. Arthritis Care Res (Hoboken) 2024; 76:585-589. [PMID: 38148587 DOI: 10.1002/acr.25286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 12/28/2023]
Affiliation(s)
- Brian D Jaros
- Northwestern University and Northwestern University Hospital, Chicago, Illinois
| | | | - Marcy B Bolster
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Anisha B Dua
- Northwestern University and Northwestern University Hospital, Chicago, Illinois
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Boy K, von Rohr S, May S, Kuhn S, Schett G, Labinsky H, Knitza J, Muehlensiepen F. Pre-assessment of patients with suspected axial spondyloarthritis combining student-led clinics and telemedicine: a qualitative study. Rheumatol Int 2024; 44:663-673. [PMID: 38289350 PMCID: PMC10914903 DOI: 10.1007/s00296-023-05522-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/15/2023] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Patients referred to rheumatologists are currently facing months of inefficient waiting time due to the increasing demand and rising workforce shortage. We piloted a pre-assessment of patients with suspected axial spondyloarthritis (axSpA) combining student-led clinics and telemedicine (symptom assessment, symptom monitoring and at-home capillary self-sampling) to improve access to rheumatology care. The aim of this study was to explore (1) current challenges accessing axSpA care and (2) patients' first-hand experiences. METHODS Embedded within a clinical trial, this study was based on qualitative interviews with patients with suspected axSpA (n = 20). Data was analysed via qualitative content analysis. RESULTS Student-led clinics were perceived as high-quality care, comparable to conventional rheumatologist-led visits. Patients expressed that their interactions with the students instilled a sense of trust. History-taking and examinations were perceived as comprehensive and meticulous. Telehealth tools were seen as empowering, offering immediate and continuous access to symptom assessment at home. Patients reported a lack of specificity of the electronic questionnaires, impeding accurate responses. Patients requested a comments area to supplement questionnaire responses. Some patients reported receiving help to complete the blood collection. CONCLUSION Patients' access to rheumatology care is becoming increasingly burdensome. Pre-assessment including student-led clinics and telemedicine was highly accepted by patients. Patient interviews provided valuable in-depth feedback to improve the piloted patient pathway.
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Affiliation(s)
- Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany.
| | - Sophie von Rohr
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany
| | - Sebastian Kuhn
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Würzburg, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology Friedrich, Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps University Marburg, Marburg, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf Bei Berlin, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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Muehlensiepen F, Petit P, Knitza J, Welcker M, Vuillerme N. Prediction of the acceptance of telemedicine among rheumatic patients: a machine learning-powered secondary analysis of German survey data. Rheumatol Int 2024; 44:523-534. [PMID: 38206379 PMCID: PMC10866795 DOI: 10.1007/s00296-023-05518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/06/2023] [Indexed: 01/12/2024]
Abstract
Telemedicine (TM) has augmented healthcare by enabling remote consultations, diagnosis, treatment, and monitoring of patients, thereby improving healthcare access and patient outcomes. However, successful adoption of TM depends on user acceptance, which is influenced by technical, socioeconomic, and health-related factors. Leveraging machine learning (ML) to accurately predict these adoption factors can greatly contribute to the effective utilization of TM in healthcare. The objective of the study was to compare 12 ML algorithms for predicting willingness to use TM (TM try) among patients with rheumatic and musculoskeletal diseases (RMDs) and identify key contributing features. We conducted a secondary analysis of RMD patient data from a German nationwide cross-sectional survey. Twelve ML algorithms, including logistic regression, random forest, extreme gradient boosting (XGBoost), and neural network (deep learning) were tested on a subset of the dataset, with the inclusion of only RMD patients who answered "yes" or "no" to TM try. Nested cross-validation was used for each model. The best-performing model was selected based on area under the receiver operator characteristic (AUROC). For the best-performing model, a multinomial/multiclass ML approach was undertaken with the consideration of the three following classes: "yes", "no", "do not know/not answered". Both one-vs-one and one-vs-rest strategies were considered. The feature importance was investigated using Shapley additive explanation (SHAP). A total of 438 RMD patients were included, with 26.5% of them willing to try TM, 40.6% not willing, and 32.9% undecided (missing answer or "do not know answer"). This dataset was used to train and test ML models. The mean accuracy of the 12 ML models ranged from 0.69 to 0.83, while the mean AUROC ranged from 0.79 to 0.90. The XGBoost model produced better results compared with the other models, with a sensitivity of 70%, specificity of 91% and positive predictive value of 84%. The most important predictors of TM try were the possibility that TM services were offered by a rheumatologist, prior TM knowledge, age, self-reported health status, Internet access at home and type of RMD diseases. For instance, for the yes vs. no classification, not wishing that TM services were offered by a rheumatologist, self-reporting a bad health status and being aged 60-69 years directed the model toward not wanting to try TM. By contrast, having Internet access at home and wishing that TM services were offered by a rheumatologist directed toward TM try. Our findings have significant implications for primary care, in particular for healthcare professionals aiming to implement TM effectively in their clinical routine. By understanding the key factors influencing patients' acceptance of TM, such as their expressed desire for TM services provided by a rheumatologist, self-reported health status, availability of home Internet access, and age, healthcare professionals can tailor their strategies to maximize the adoption and utilization of TM, ultimately improving healthcare outcomes for RMD patients. Our findings are of high interest for both clinical and medical teaching practice to fit changing health needs caused by the growing number of complex and chronically ill patients.
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Affiliation(s)
- Felix Muehlensiepen
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France.
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, 15562, Rüdersdorf bei Berlin, Germany.
| | - Pascal Petit
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
| | - Johannes Knitza
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
| | - Nicolas Vuillerme
- Univ. Grenoble Alpes, AGEIS, 38000, Grenoble, France
- Institut Universitaire de France, Paris, France
- LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
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Muehlensiepen F, Hoffmann MJ, Nübel J, Ignatyev Y, Heinze M, Butter C, Haase-Fielitz A. Acceptance of Telemedicine by Specialists and General Practitioners in Cardiology Care: Cross-Sectional Survey Study. JMIR Form Res 2024; 8:e49526. [PMID: 38376898 PMCID: PMC10915724 DOI: 10.2196/49526] [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: 06/01/2023] [Revised: 11/27/2023] [Accepted: 11/27/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND In the coming years, telemedicine will play a key role in health care. Especially in rural areas with weak infrastructure, telemedicine could be crucial to providing adequate and personalized medical care. OBJECTIVE We investigated the acceptance and preferences of telemedicine among cardiologists, internists, and general practitioners. In addition, we aimed to identify knowledge, explore factors that influence the decision to adopt or reject this technology, and create starting points for demand-oriented further research. METHODS We conducted a web-based survey between May 2021 and February 2022. The 34-item questionnaire covered a wide range of questions regarding knowledge, acceptance, and use of telemedicine in cardiology care. Participants (cardiologists, internists, and general practitioners) were contacted through their professional email addresses, through a QR code published in a regional health journal, and through X (formerly known as Twitter). After exclusion of questionnaires with missed values, multidimensional scaling and k-means clustering were performed. Participants were divided into 3 clusters (C1, C2, and C3) based on their attitudes toward telecardiology. C1 uses telemedicine for personal health and clinical practice; C2 shows reluctance; C3 uses telemedicine mainly clinically. RESULTS We contacted 929 physicians. Of those 12.1% (112/929) completed the questionnaires. Participants were 56% male (54/97), 29% female (28/97), and 2% (2/97) diverse (median age 50 years). About 16% (18/112) of the respondents currently use telemedicine daily, 14.3% (16/112) 3-4 times a week, and 43% (48/112) did not use telemedicine at all. Overall, 35.1% (34/97) rated their knowledge of telemedicine as very good or good. Most of the respondents replied that telemedicine could support cardiology care in monitoring of blood pressure and electrocardiograms (57/97, 58.8%, both), consultation (57/97, 58.8%), and extending follow-up time (59/97, 60.8%). Reported barriers to implementation were mostly administration (26/97, 26.8%), inadequate reimbursement (25/97, 25.8%), and the purchase of technology equipment (23/97, 23.7%). Attitudes toward telemedicine in clinical practice were closely related to the number of patients being treated per annual quarter: C3 (median 1350, IQR 1000-1500) versus C1 (median 750, IQR 300-1200) and C2 (median 500, IQR 105-825). The differences between clinical caseloads of C1-C3 members were significant: C1 versus C2 (P=.03), C1 versus C3 (P=.02), and C2 versus C3 (P<.001). Most participants (87/112, 77.7%) would like to expand telemedicine approaches in the future. In the field of cardiology, the participants reported a high suitability of telemedicine. The willingness to train in telemedicine is high to very high for > 50% of the participants. CONCLUSIONS Our results indicate generally moderate use but positive attitudes toward telemedicine among participating physicians with a higher clinical caseload. The lack of a structural framework seems to be a barrier to the effective implementation of telecardiology.
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Affiliation(s)
- Felix Muehlensiepen
- Brandenburg Medical School (MHB) and Faculty of Health Sciences (FGW) Brandenburg, Neuruppin, Germany
- Autonomie, Gérontologie, E-santé, Imagerie et Société (AGEIS), Université Grenoble Alpes, Grenoble, France
| | - Marie Josephine Hoffmann
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Neuruppin, Germany
| | - Jonathan Nübel
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Neuruppin, Germany
| | - Yury Ignatyev
- Department for Psychiatry and Psychotherapy, University Hospital Immanuel Klinik Rüdersdorf, Brandenburg Medical School (MHB), Rüdersdorf, Germany
| | - Martin Heinze
- Department for Psychiatry and Psychotherapy, University Hospital Immanuel Klinik Rüdersdorf, Brandenburg Medical School (MHB), Rüdersdorf, Germany
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Neuruppin, Germany
| | - Anja Haase-Fielitz
- Brandenburg Medical School (MHB) and Faculty of Health Sciences (FGW) Brandenburg, Neuruppin, Germany
- Department of Cardiology, Heart Center Brandenburg Bernau & Faculty of Health Sciences (FGW) Brandenburg, Brandenburg Medical School (MHB), Neuruppin, Germany
- Institute of Social Medicine and Health System Research, Otto von Guericke University, Magdeburg, Germany
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May S, Darkow R, Knitza J, Boy K, Schwarz J, Heinze M, Hornig J, Aries P, Welcker M, Muehlensiepen F. "The Simpler, the Better." A Qualitative Study on Digital Health Transformation in Early Adopter Rheumatology Outpatient Clinics. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241247021. [PMID: 38801153 PMCID: PMC11131398 DOI: 10.1177/00469580241247021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/22/2023] [Accepted: 03/25/2023] [Indexed: 05/29/2024]
Abstract
Workforce shortage and the increasing burden of rheumatic and musculoskeletal diseases lead to extreme time constraints in rheumatology outpatient care. Digital services promise to facilitate care by relieving employees and unleash new capacities. This study aims to explore the perspectives of early adopter health care professionals (HCP) on digital transformation in outpatient rheumatology. In-depth qualitative interviews were conducted with rheumatology nurses and physicians in 3 German rheumatology outpatient clinics, each characterized by an advanced level of digital adaption. Qualitative data were subsequently analyzed using deductive-inductive qualitative content analysis. Interviews with 11 rheumatology nurses and 5 rheumatologists were completed. Three key themes emerged from the qualitative analysis: (i) Digital transformation of care; (ii) impact of digital transformation on health care delivery; and (iii) perceived drivers of successful digitalization. The interviews revealed that digital technologies are widely used throughout the complete patient pathway. Digitalization enables more continuity and flexibility in rheumatology care. Patient information can be electronically obtained in a standardized manner prior to planned visits, enabling an informed consultation and more time for in-depth patient discussion. Although digitalization restructures work, it can also increase the current workload. Improved accessibility for patient calls leads to more work for HCP. Important drivers of successful digital technology implementation are low-threshold and interoperable services, a medical team that is interested and educated in eHealth, and comprehensive patient information and onboarding. Digital transformation is increasingly redefining rheumatology care. While accelerating communication and workflows, improved service accessibility leads to more work for HCP.
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Affiliation(s)
- Susann May
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | | | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Katharina Boy
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Julian Schwarz
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Martin Heinze
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | | | - Peer Aries
- Immunologikum Hamburg, Rheumatologie and Klinische Immunologie, Hamburg, Germany
| | - Martin Welcker
- MVZ für Rheumatologie Dr. Martin Welcker GmbH, Planegg, Germany
| | - Felix Muehlensiepen
- Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- AGEIS, Université Grenoble Alpes, Grenoble, France
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10
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Tan TC, Roslan NEB, Li JW, Zou X, Chen X, Santosa A. Patient Acceptability of Symptom Screening and Patient Education Using a Chatbot for Autoimmune Inflammatory Diseases: Survey Study. JMIR Form Res 2023; 7:e49239. [PMID: 37219234 PMCID: PMC11019963 DOI: 10.2196/49239] [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: 05/23/2023] [Revised: 08/27/2023] [Accepted: 11/05/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Chatbots have the potential to enhance health care interaction, satisfaction, and service delivery. However, data regarding their acceptance across diverse patient populations are limited. In-depth studies on the reception of chatbots by patients with chronic autoimmune inflammatory diseases are lacking, although such studies are vital for facilitating the effective integration of chatbots in rheumatology care. OBJECTIVE We aim to assess patient perceptions and acceptance of a chatbot designed for autoimmune inflammatory rheumatic diseases (AIIRDs). METHODS We administered a comprehensive survey in an outpatient setting at a top-tier rheumatology referral center. The target cohort included patients who interacted with a chatbot explicitly tailored to facilitate diagnosis and obtain information on AIIRDs. Following the RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) framework, the survey was designed to gauge the effectiveness, user acceptability, and implementation of the chatbot. RESULTS Between June and October 2022, we received survey responses from 200 patients, with an equal number of 100 initial consultations and 100 follow-up (FU) visits. The mean scores on a 5-point acceptability scale ranged from 4.01 (SD 0.63) to 4.41 (SD 0.54), indicating consistently high ratings across the different aspects of chatbot performance. Multivariate regression analysis indicated that having a FU visit was significantly associated with a greater willingness to reuse the chatbot for symptom determination (P=.01). Further, patients' comfort with chatbot diagnosis increased significantly after meeting physicians (P<.001). We observed no significant differences in chatbot acceptance according to sex, education level, or diagnosis category. CONCLUSIONS This study underscores that chatbots tailored to AIIRDs have a favorable reception. The inclination of FU patients to engage with the chatbot signifies the possible influence of past clinical encounters and physician affirmation on its use. Although further exploration is required to refine their integration, the prevalent positive perceptions suggest that chatbots have the potential to strengthen the bridge between patients and health care providers, thus enhancing the delivery of rheumatology care to various cohorts.
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Affiliation(s)
- Tze Chin Tan
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
| | - Nur Emillia Binte Roslan
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of General Medicine, Sengkang General Hospital, Singapore, Singapore
| | - James Weiquan Li
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
| | - Xinying Zou
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Xiangmei Chen
- Internal Medicine Clinic, Changi General Hospital, Singapore, Singapore
| | - Anindita Santosa
- Medicine Academic Clinical Programme, SingHealth-Duke-NUS, Singapore, Singapore
- Division of Rheumatology and Immunology, Department of Medicine, Changi General Hospital, Singapore, Singapore
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11
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Ziade N, Hmamouchi I, Haouichat C, Baron F, Al Mayouf S, Abdulateef N, Masri B, El Rakawi M, El Kibbi L, El Mashaleh M, Elzorkany B, Al Saleh J, Dejaco C, Abutiban F. The rheumatology workforce in the Arab countries: current status, challenges, opportunities, and future needs from an ArLAR cross-sectional survey. Rheumatol Int 2023; 43:2281-2292. [PMID: 37624401 DOI: 10.1007/s00296-023-05427-x] [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: 06/24/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
The Arab League of Associations for Rheumatology (ArLAR) Research Group (ARCH) conducted this study to investigate the number of current practicing rheumatologists in the Arab countries, to estimate the projected number of rheumatologists in 10 years, and to evaluate the current workload, practice profile, consultation waiting time, and geographical mobilities of these rheumatologists. This cross-sectional survey study was conducted in 16 Arab countries in two parts. The first survey was addressed nominally to national societies to estimate the current and projected workforce. The second was an anonymous e-survey elaborated by the study steering committee on the Google Forms platform and distributed to Arab rheumatologists using social media, WhatsApp, and mass e-mails to evaluate their practice. The mean number of rheumatologists in Arab countries was 0.84 per 100,000 inhabitants (mean age 47.5 years, 55% females), ranging from 0.06 (Sudan) to 1.86 (Tunisia). The number of rheumatologists is expected to increase by 50% in 2032. Nevertheless, a 20% increase in population associated with an increase in demand is also expected. Data from 446 rheumatologists (mean age 43.9 years, 60.5% females) revealed that 72% worked full-time, and 53% were employed in the public sector only. The average waiting time for a rheumatology consultation was 19.9 days. Of 394 rheumatologists, 19% obtained their rheumatology diplomas from non-Arab countries, and 47% of Gulf rheumatologists were non-citizen physicians. Considering local demographic disparities, healthcare system differences, and geographical mobilities, national authorities are advised to implement effective intervention plans to optimize the rheumatology workforce.
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Affiliation(s)
- Nelly Ziade
- Rheumatology Department, Saint-Joseph University, Beirut, Lebanon.
- Tour Des Consultations Externes, Hotel-Dieu de France Hospital, 6th Floor, Alfred Naccache blvd., Achrafieh, Beirut, Lebanon.
| | - Ihsane Hmamouchi
- Laboratory of Clinical Research and Epidemiology, Faculty of Medicine, Mohammed V University, Rabat, Morocco
- Department of Medicine, Health Sciences College, International University of Rabat (UIR), Rabat, Morocco
| | - Chafika Haouichat
- Rheumatology Department, Djillali Bounaama University Hospital, Douera, Algeria
- Rheumatology Department, Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Fatemah Baron
- Unit of Rheumatology, Internal Medicine Department, Al-Jahra Hospital, Ministry of Health, Kuwait City, State of Kuwait
| | - Sulaiman Al Mayouf
- Division of Rheumatology, Department of Pediatrics, King Faisal Specialist Hospital and Research Center. College of Medicine, Al Faisal University, Riyadh, Saudi Arabia
| | - Nizar Abdulateef
- Rheumatology Unit, Department of Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq
| | - Basel Masri
- Rheumatology Division, Department of Internal Medicine, Jordan Hospital and Medical Center, Amman, Jordan
| | - Manal El Rakawi
- Rheumatology Department, Faculty of Medicine El Mahdi Si Ahmed, Blida, Algeria
| | - Lina El Kibbi
- Division of Rheumatology, Department of Internal Medicine, Specialized Medical Center, Riyadh, Saudi Arabia
| | - Manal El Mashaleh
- Rheumatology Division of Internal Medicine, King Hussein Medical Center, Royal Medical Services, Jordan Armed Forces, Amman, Jordan
| | | | | | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES), Brunico, Italy
| | - Fatemah Abutiban
- Unit of Rheumatology, Department of Internal Medicine, Jaber Alahmed Hospital, Ministry of Health, Kuwait City, State of Kuwait
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12
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Thomassen EEK, Berg IJ, Kristianslund EK, Tveter AT, Østerås N. Willingness, perceived facilitators and barriers to use remote care among healthcare professionals - a cross-sectional study. BMC Health Serv Res 2023; 23:1307. [PMID: 38012633 PMCID: PMC10683299 DOI: 10.1186/s12913-023-10301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Remote care has the potential of improving access to timely care for people with inflammatory joint diseases (IJD), but there is limited knowledge on how this approach is regarded by healthcare professionals (HCP). This study aimed to examine willingness, perceived facilitators, and barriers to use remote care among HCP. METHODS Employees at 20 rheumatology departments in Norway received a digital survey containing 16 statements regarding willingness, perceived facilitators and barriers to use remote care. Statements were scored using numeric rating scales (NRS, 0-10, 10 = strongly agree), and analysed in linear regression models. Open-ended responses with participant-defined facilitators and barriers were analysed using qualitative manifest analysis. RESULTS A total of 130 participants from 17 departments completed the survey. The majority of participants were 45 years or older (n = 84, 54%), 54 (42%) were medical doctors, 48 (37%) nurses, and 27 (21%) were allied healthcare professionals, clinical leaders, or secretaries. A high willingness to use remote care was observed (median NRS: 9, IQR 8-10). The facilitator statement with the highest score was that patients save time and costs by using remote care, whereas the barrier statement with the highest score was the lack of physical examination. Willingness to use remote care was positively associated with the belief that patients wish to use it (β: 0.18, 95% CI: 0.00, 0.34), that patients in remission need less hospital visits (β: 0.30, 95% CI: 0.16, 0.43), and if remote care is widely adopted by co-workers (β: 0.27, 95% CI: 0.15, 0.39). Willingness was negatively associated with mistrust in the technical aspects of remote care (β: -0.26, 95% CI:-0.40, -0.11), and lack of physical examination (β: -0.24, 95% CI: -0.43, -0.06). The open-ended responses showed that technological equipment, eligible patients, user-friendly software, adequate training and work flow could be facilitators, but also that lack of these factors were considered barriers to use remote care. CONCLUSION This study showed that HCP have a high willingness to use remote care, and provides important new knowledge on perceived facilitators and barriers among HCP relevant for implementation of remote care for eligible patients with IJD.
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Affiliation(s)
| | - Inger Jorid Berg
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Klami Kristianslund
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Anne Therese Tveter
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Østerås
- Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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13
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Mohammed Murad A, Farman F, Sunmboye KO. Chest X-ray Reporting: A Comparative Study of Specialist Nurses and Trainee Doctors' Knowledge in the Biologic Prescription Service. Cureus 2023; 15:e48801. [PMID: 38098937 PMCID: PMC10719551 DOI: 10.7759/cureus.48801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 12/17/2023] Open
Abstract
With all the challenges facing the NHS at the current time, specialist nurses are fundamental and an important part of an ever-expanding NHS workforce. Furthermore, specialist nurses now possess more diversity and a wide range of advanced skills. In the field of rheumatology in most NHS hospitals, specialist nurses play a key role in biologic services to ensure that patients are promptly started on biological therapy to control their disease. An important element of this workup is the ability to comment on an unreported chest radiograph to facilitate a biological prescription. Some studies have shown that there is limited expertise among non-doctors with the required skills to review unreported chest X-rays confidently. The authors of this paper sought to explore whether this is the case among specialist nurses involved in the biologic prescription service among other clinicians in the same service. An online questionnaire was designed by the authors, which included seven questions and responses collected on a 5-point Likert scale. Trainee doctors, non-trainee grade doctors, and specialist nurses who were involved in the biologic prescribing team from Rheumatology, Dermatology, and Gastroenterology were invited. A total of 56 responses were obtained and analyzed. Descriptive and inferential statistics were obtained from the data. To determine if there was a statistical difference between the responses of trainee doctors and specialist nurses, the Kruskal-Wallis statistical test was used, and a post hoc test using the Dunn-Bonferroni test was used to analyze any statistically significant results. Regarding chest X-ray interpretation prior to starting biological treatment, only 8% of specialist nurses reported being confident, whereas 63% of trainees reported being confident. The Kruskal-Wallis test revealed a significant difference between specialist nurses' and doctors' confidence in interpreting unreported chest radiographs. The P-value is 0.001; thus, with available data, the null hypothesis is rejected. A Dunn-Bonferroni test (post hoc test) showed that, based on the available data, it can be assumed that the two groups had different levels of confidence between Specialist Nurses and trainee doctors. Chest X-ray interpretation skills are vital for specialist nurses in the context of biological therapy prescriptions. Therefore, we recommend access to resources, ongoing formal training, and educational sessions to help specialist nurses maintain their advanced skill sets and broaden their scope of practice to those without the required expertise.
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Affiliation(s)
- Awin Mohammed Murad
- General Internal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Fatima Farman
- General Internal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| | - Kehinde O Sunmboye
- Health Sciences, University of Leicester, Leicester, GBR
- Rheumatology, University Hospitals of Leicester NHS Trust, Leicester, GBR
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14
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Kheirkhah H, Hartfeld NMS, Widdifield J, Kulhawy-Wibe S, Roberts J, Yacyshyn EA, Lee JJY, Jilkine K, Jerome D, Kwok TSH, Burt J, Barber CEH. An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists. J Rheumatol 2023; 50:1488-1502. [PMID: 37527857 DOI: 10.3899/jrheum.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists. METHODS A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology. RESULTS A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness. CONCLUSION Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.
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Affiliation(s)
- Hengameh Kheirkhah
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Sunnybrook Research Institute, University of Toronto, ICES, Toronto, Ontario
| | - Stephanie Kulhawy-Wibe
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Janet Roberts
- J. Roberts, MD, Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elaine A Yacyshyn
- E.A. Yacyshyn, MD, MScHQ, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Konstantin Jilkine
- K. Jilkine, MD, Section of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Dana Jerome
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Timothy S H Kwok
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, Rheumatology Services, Eastern Health, St. John's, Newfoundland and Labrador
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
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15
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Vinci RJ, Clapp DW, Reed A, Degnon L. A Flattening of the Curve: The Challenge of Disparate Growth Rates in the Pediatric Subspecialties. J Pediatr 2023; 261:113509. [PMID: 37301280 DOI: 10.1016/j.jpeds.2023.113509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023]
Affiliation(s)
- Robert J Vinci
- Department of Pediatrics, Boston Medical Center, Boston University School of Medicine, Boston, MA.
| | - D Wade Clapp
- Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN
| | - Ann Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University School of Medicine, Durham, NC
| | - Laura Degnon
- Association of Medical School Pediatric Department Chairs, McLean, VA
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16
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von Rohr S, Knitza J, Grahammer M, Schmalzing M, Kuhn S, Schett G, Ramming A, Labinsky H. Student-led clinics and ePROs to accelerate diagnosis and treatment of patients with axial spondyloarthritis: results from a prospective pilot study. Rheumatol Int 2023; 43:1905-1911. [PMID: 37486433 PMCID: PMC10435605 DOI: 10.1007/s00296-023-05392-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 07/01/2023] [Indexed: 07/25/2023]
Abstract
We aimed to investigate (1) student-led clinics and (2) electronic patient-reported outcomes (ePROs) to accelerate diagnosis and treatment of patients with axial spondyloarthritis (axSpA). Patients with suspected axSpA completed an initial student-led clinic visit (T-1) prior to their planned actual rheumatologist visit (T0). Acceleration of patient appointment and NSAID therapy start, availability of diagnostic findings, and treatment response at T0 were evaluated. Beginning at T-1, patients completed electronic BASDAI questionnaires every 2 weeks. Concordance of paper-based and electronic BASDAI was evaluated. Patient acceptance of ePRO reporting and student-led clinics was measured using the net promoter score (NPS). 17/36 (47.2%) included patients were diagnosed with axSpA. Student-led clinics (T-1) significantly accelerated patient appointments by more than 2 months (T0, T-1, p < 0.0001) and axSpA guideline-conform NSAID treatment (p < 0.0001). At T0, diagnostic workup was completed for all patients and 7/17 (41.2%) axSpA patients presented with a clinically important improvement or were in remission. 34/36 (94.4%) patients completed at least 80% of the ePROs between T-1 and T0. Electronic and paper-administered BASDAI correlated well (r = 0.8 p < 0.0001). Student-led clinics and ePROs were well accepted by patients with NPS scores of + 62.0% (mean ± SD 9.2/10.0 ± 0.9) and + 30.5% (mean ± SD 8.0/10.0 ± 1.7), respectively. In conclusion, student-led clinics and ePRO monitoring were well accepted, accelerated diagnostic workup and treatment in patients with axSpA.
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Affiliation(s)
- Sophie von Rohr
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Johannes Knitza
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
| | - Manuel Grahammer
- Abaton GmbH, Berlin, Germany
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
| | - Marc Schmalzing
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
| | - Sebastian Kuhn
- Institute for Digital Medicine, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Hannah Labinsky
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 2, Rheumatology/Clinical Immunology, University Hospital Würzburg, Oberdürrbacher Straße 6, Würzburg, Germany
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17
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Barnett R, Clarke C, Sengupta R, Rouse PC. Protocol for a systematic literature review of smartphone apps to support the self-management of rheumatic and musculoskeletal diseases: development strategies, theoretical underpinnings and barriers to engagement. Syst Rev 2023; 12:129. [PMID: 37516896 PMCID: PMC10385957 DOI: 10.1186/s13643-023-02276-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 06/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Rheumatic and musculoskeletal diseases (RMDs) cause significant burden to the individual and society, requiring lifelong management and specialist healthcare resource use. Costing over 200 billion euros per year in Europe, RMDs are the most expensive of all diseases for European healthcare systems. The incidence and burden of RMDs are projected to rise with the ageing global population and increase in sedentary, obesogenic lifestyles. In parallel, there is a global crisis in the rheumatology workforce, whereby capacity to deliver specialist care is being exceeded by demand. Pervasive, scalable mobile health technologies, such as apps, are being developed to support the self-management of RMDs and reduce pressure on healthcare services. However, it is unknown whether these apps are informed by theory or their use supported by an appropriate evidence base. The purpose of this review is therefore to provide a comprehensive overview of the development strategies, interventional components and theoretical underpinnings of existing smartphone apps, designed to support the self-management of RMDs. METHODS Searches will be conducted within PubMed, Scopus, Web of Science, Embase, MEDLINE and PsycINFO. Reference lists and citing articles of the included studies will be searched. Identified publications will be screened for eligibility by two independent reviewers. Any discrepancies between reviewers will be resolved by consensus, with input from a third reviewer if required. Data will be extracted on study designs, methods, populations, setting, utilised theoretical frameworks, intervention components, behaviour change techniques, methods to evaluate effectiveness and barriers/facilitators to intervention engagement. Exploratory outcomes include reported effectiveness, acceptability and usability. A systematic, narrative synthesis of evidence will be presented. If appropriate (depending on quality and pool of evidence identified), qualitative meta-summary techniques will be used to combine and summarise qualitative findings regarding barriers/facilitators to intervention engagement. DISCUSSION The results of this systematic literature review will provide insights for healthcare professionals, researchers, app designers and policy makers, to inform future development and implementation of smartphone apps to support self-management of RMDs. Evidence gaps for future research will be identified. Findings will be disseminated through a final manuscript/publication of results and via a conference abstract, patient organisations and social media. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022359704.
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Affiliation(s)
- Rosemarie Barnett
- Department for Health, University of Bath, Bath, UK.
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK.
| | | | - Raj Sengupta
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
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18
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Saag KG. ACR Presidential Address: Rheumatologists-Folks You Can Trust. Arthritis Rheumatol 2023; 75:645-649. [PMID: 36932462 DOI: 10.1002/art.42475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 03/19/2023]
Affiliation(s)
- Kenneth G Saag
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham; President, American College of Rheumatology, 2021-2022
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19
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Burnout in South Asian rheumatologists in the COVID-19 pandemic: an online survey. Rheumatol Int 2023; 43:1143-1150. [PMID: 36917244 PMCID: PMC10012323 DOI: 10.1007/s00296-023-05304-7] [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: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
Physician burnout is recognized as a global crisis and an epidemic. However, burnout in rheumatology is an understudied phenomenon. We explored the prevalence of physician burnout among rheumatologists from South Asia in the peri-pandemic period (2021-2022). Rheumatologists from Asian countries were invited to participate in an anonymized, validated, and pilot-tested e-survey via social media platforms from December 2021 to April 2022. Demographic information, social aspects (marital status, income, vacation time, daily exercise), substance abuse, EHR (electronic health record) use, and years in practice were obtained. In addition, burnout was estimated using Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS) in three domains: emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), and intergroup comparisons were made using independent t test and one-way ANOVA using SPSS v27. Of 146 respondents who participated in the survey, 134 belonged to Asian nations. The highest number of respondents was from Pakistan (56/134, 38.36%), followed by India (49/134, 33.56%). Slightly more respondents were male, 75 (51.4%), than females, 71 (48.6%). Over two-thirds of our respondents (99/134, 67.8%) reported burnout in at least one domain. Notably, we found statistically significant increased depersonalization scores in males. (P < 0.05). Females scored significantly higher on the following items: #5 (I feel I treat some patients as if they were impersonal objects), item# 10 (I've become more insensitive toward people since I took this job and item#22 (I feel patients blame me for some of their problems) (P < 0.05). We found differences in monthly salaries among South Asian (1484 ± 2717 USD) and non-South Asian respondents (5672 ± 8874 USD) (P < 0.01). A substantial proportion of rheumatologists in our survey report burnout, suggesting a felt need to introduce organizational measures to prevent and mitigate burnout and preserve the rheumatology workforce.
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Hermans K, Boonen A, Vonkeman HE, van Tubergen A. Effectiveness and cost-effectiveness of combined asynchronous telemonitoring and patient-initiated care for spondyloarthritis: protocol for a pragmatic multicentre randomised controlled trial (TeleSpA Study). BMJ Open 2023; 13:e067445. [PMID: 36806136 PMCID: PMC9944312 DOI: 10.1136/bmjopen-2022-067445] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, an accelerated uptake of remote monitoring strategies, replacing traditional face-to-face care, has been observed. However, data on the effects of remote care interventions for patients with rheumatic and musculoskeletal diseases remain scarce and interpretation is hampered by study heterogeneity and research quality concerns. High-quality evidence is required to guide future implementation in clinical practice, with health economic analyses identified as an important knowledge gap. Randomised controlled trials (RCTs) comparing telemonitoring with conventional care for patients with spondyloarthritis (SpA) are currently lacking. METHODS AND ANALYSIS TeleSpA is a pragmatic, multicentre RCT investigating the effectiveness and cost-effectiveness of combined asynchronous telemonitoring and patient-initiated follow-up for patients with SpA, compared with conventional care. Two-hundred patients will be recruited at two hospitals and randomised (1:1) to the study intervention or standard care. The primary endpoint is a reduction in the number of follow-up visits by ≥25% in the intervention compared with standard care group, during a 1-year period. Secondary endpoints are (a) non-inferiority of the study intervention with regard to health outcomes, quality of care and patient-reported experience with care; and (b) cost-effectiveness of the intervention, evaluated through a prospective trial-based cost-utility analysis. In addition, experiences with the study intervention will be assessed among patients and healthcare providers, and factors associated with primary and secondary endpoints will be identified. ETHICS AND DISSEMINATION This study was approved by the Medical Research Ethics Committee of the Academic Hospital Maastricht/Maastricht University (NL71041.068.19/METC 19-059). Results will be disseminated through publications in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER NCT04673825.
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Affiliation(s)
- Kasper Hermans
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
| | - Harald E Vonkeman
- Department of Rheumatology and Clinical Immunology, Medisch Spectrum Twente, Enschede, The Netherlands
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Astrid van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Care and Public Health Research Institute (CAPHRI), Maastricht University Faculty of Health Medicine and Life Sciences, Maastricht, The Netherlands
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21
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Eysenbach G, Petit P, Knitza J, Welcker M, Vuillerme N. Factors Associated With Telemedicine Use Among Patients With Rheumatic and Musculoskeletal Disease: Secondary Analysis of Data From a German Nationwide Survey. J Med Internet Res 2023; 25:e40912. [PMID: 36705950 PMCID: PMC9919449 DOI: 10.2196/40912] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 10/25/2022] [Accepted: 11/16/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Previous studies have demonstrated telemedicine (TM) to be an effective tool to complement rheumatology care and address workforce shortage. With the outbreak of the COVID-19 pandemic, TM experienced a massive upswing. A previous study revealed that physicians' willingness to use TM and actual use of TM are closely connected to their knowledge of TM. However, it remains unclear which factors are associated with patients' motivation to use TM. OBJECTIVE This study aims to identify the factors that determine patients' willingness to try TM (TM try) and their wish that their rheumatologists offer TM services (TM wish). METHODS We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with rheumatic and musculoskeletal disease (RMD). Bayesian univariate and multivariate logistic regression analyses were applied to the data to determine which factors were associated with TM try and TM wish. The predictor variables (covariates) studied individually included sociodemographic factors (eg, age and sex) and health characteristics (eg, disease type and health status). All the variables positively or negatively associated with TM try or TM wish in the univariate analyses were then considered for the Bayesian model averaging analysis after a selection based on the variance inflation factor (≤2.5). All the analyses were stratified by sex. RESULTS Of the total 102 variables, 59 (57.8%) and 45 (44.1%) variables were found to be positively or negatively associated (region of practical equivalence ≤5%) with TM try and TM wish, respectively. A total of 16 and 8 determinant factors were identified for TM try and TM wish, respectively. Wishing that TM services were offered by rheumatologists, having internet access at home, residing 5 to 10 km away from the general practitioner's office, owning an electronic device, and being aged 40 to 60 years were among the factors positively associated with TM try and TM wish. By contrast, not yet being diagnosed with an RMD, having no prior knowledge of TM, having a bad health status, living in a rural area, not documenting one's health status, not owning an electronic device, and being aged 60 to 80 years were negatively associated with TM try and TM wish. CONCLUSIONS Our results suggest that health status, knowledge, age, and access to technical equipment and infrastructure influence the motivation of patients with RMD to use telehealth services. In particular, older patients with RMD living in rural areas, who could likely benefit from using TM, are currently not motivated to use TM and seem to need additional TM support.
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Affiliation(s)
| | - Pascal Petit
- AGEIS, Université Grenoble Alpes, Grenoble, France
| | - Johannes Knitza
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr M Welcker GmbH, Planegg, Germany
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, Grenoble, France.,Institut Universitaire de France, Paris, France.,LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
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22
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Mbonu I, Tai S, Bartels CM, Putman M. Association Between Neighborhood Deprivation and Number of Rheumatology Providers. Arthritis Care Res (Hoboken) 2023; 75:9-13. [PMID: 36205227 DOI: 10.1002/acr.25036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/21/2022] [Accepted: 10/04/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Geographic disparities in the distribution and practice patterns of rheumatology providers may negatively impact patients with rheumatic diseases. The objective of this study was to describe the distribution of rheumatologists with respect to the Area Deprivation Index (ADI) and to identify differences in practice patterns among Medicare Part D rheumatologist prescribers. METHODS We identified 5,882 rheumatologists who served a mean ± SD of 280 ± 208 Medicare Part D beneficiaries per year. In a Poisson regression model of the number of rheumatologists and the ADI of their practice location, for every increase of 10 on the ADI scale (range 0-100; higher = higher deprivation), there were 20.3% fewer rheumatologists (P < 0.001), resulting in 2.1 times as many rheumatologists per 100,000 people in the first ADI quintile when compared to the fifth ADI quintile. RESULTS The number of rheumatologists peaked in 2016 and decreased steadily thereafter across all quintiles. The prescribing rate per 100 beneficiaries was significantly different between quintiles across all studied drug classes except for opioids, but the trends were inconsistent and of unclear clinical significance. CONCLUSION Rheumatologists tended to practice in areas with less deprivation, resulting in twice as many rheumatologists per 100,000 people in the quintile of lowest deprivation as opposed to the quintile with the highest deprivation. Public policy makers should be aware of these data and take steps to mitigate disparities in access to care as the rheumatology workforce shrinks.
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23
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Semaka A, Katz SJ. Rheumatology Image of the Month: A Low Resource Innovation With Measurable Results. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231164027. [PMID: 36936181 PMCID: PMC10021094 DOI: 10.1177/23821205231164027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 02/24/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Strategies to increase confidence in rheumatology knowledge are valuable for medical trainees and residents. A web-based teaching innovation was implemented in an attempt to increase rheumatology exposure for internal medicine residents. METHODS An Image of the Month webpage was established, where a practicing rheumatologist would post a new image that could be answered online by internal medicine residents. Cumulative data was analyzed to determine the extent and change in rheumatology exposure. RESULTS The Image of the Month webpage posted images for a total of 76 months between July 2010 to May 2017, with a total of 1326 submitted responses. The proportion of residents who only participated in Image of the Month and only did a rheumatology rotation averaged 36.1% and 16.5%, respectively. The proportion of residents who only participated in Image of the Month was higher than the proportion who only did a rheumatology rotation for all of the 7 time periods assessed. A total of 491 residents participated in Image of the Month, with an average of 54.9% of residents participating each year. Overall, on average, 52 residents had 1 or more submissions, 3.6 entries were submitted per resident, and 17.4 entries were submitted per month. Junior residents (PGY1) participated more often than senior residents (PGY3). CONCLUSIONS The Image of the Month webpage successfully improves internal medicine resident exposure to rheumatology with minimal resources and manpower required. Further study is necessary to determine the impact this exposure may have on the abilities and confidence levels of internal medicine residents.
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Affiliation(s)
- Amy Semaka
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton,
Canada
| | - Steven J Katz
- Division of Rheumatology, Department of Medicine, University of
Alberta, Edmonton, Canada
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24
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Demaerschalk BM, Hollander JE, Krupinski E, Scott J, Albert D, Bobokalonova Z, Bolster M, Chan A, Christopherson L, Coffey JD, Edgman-Levitan S, Goldwater J, Hayden E, Peoples C, Rising KL, Schwamm LH. Quality Frameworks for Virtual Care: Expert Panel Recommendations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 7:31-44. [PMID: 36619179 PMCID: PMC9811201 DOI: 10.1016/j.mayocpiqo.2022.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Given the significant advance of virtual care in the past year and half, it seems timely to focus on quality frameworks and how they have evolved collaboratively across health care organizations. Massachusetts General Hospital's (MGH) Center for TeleHealth and Mass General Brigham's (MGB) Virtual Care Program are committed to hosting annual symposia on key topics related to virtual care. Subject matter experts across the country, health care organizations, and academic medical centers are invited to participate. The inaugural MGH/MGB Virtual Care Symposium, which focused on rethinking curriculum, competency, and culture in the virtual care era, was held on September 2, 2020. The second MGH/MGB Virtual Care Symposium was held on November 2, 2021, and focused on virtual care quality frameworks. Resultant topics were (1) guiding principles necessary for the future of virtual care measurement; (2) best practices deployed to measure quality of virtual care and how they compare and align with in-person frameworks; (3) evolution of quality frameworks over time; (4) how increased adoption of virtual care has impacted patient access and experience and how it has been measured; (5) the pitfalls and barriers which have been encountered by organizations in developing virtual care quality frameworks; and (6) examples of how quality frameworks have been applied in various use cases. Common elements of a quality framework for virtual care programs among symposium participants included improving the patient and provider experience, a focus on achieving health equity, monitoring success rates and uptime of the technical elements of virtual care, financial stewardship, and clinical outcomes. Virtual care represents an evolution in the access to care paradigm that helps keep health care aligned with other modern industries in digital technology and systems adoption. With advances in health care delivery models, it is vitally important that the quality measurement systems be adapted to include virtual care encounters. New methods may be necessary for asynchronous transactions, but synchronous virtual visits and consults can likely be accommodated in traditional quality frameworks with minimal adjustments. Ultimately, quality frameworks for health care will adapt to hybrid in-person and virtual care practices.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science and Center for Digital Health, Mayo Clinic, Phoenix, AZ,Correspondence: Address to Bart M. Demaerschalk, MD, M.Sc., Mayo Clinic College of Medicine and Science and Center for Digital Health Mayo Clinic, Phoenix, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | | | - Daniel Albert
- Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Marcy Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Albert Chan
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Laura Christopherson
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jordan D. Coffey
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Susan Edgman-Levitan
- The John D. Stoekle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, MA
| | | | - Emily Hayden
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Kristin L. Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA
| | - Lee H. Schwamm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
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25
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Barber CEH, Lacaille D, Croxford R, Barnabe C, Marshall DA, Abrahamowicz M, Xie H, Avina-Zubieta JA, Esdaile JM, Hazlewood G, Faris P, Katz S, MacMullan P, Mosher D, Widdifield J. System-level performance measures of access to rheumatology care: a population-based retrospective study of trends over time and the impact of regional rheumatologist supply in Ontario, Canada, 2002-2019. BMC Rheumatol 2022; 6:86. [PMID: 36572934 PMCID: PMC9793576 DOI: 10.1186/s41927-022-00315-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/25/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To determine whether there were improvements in rheumatology care for rheumatoid arthritis (RA) between 2002 and 2019 in Ontario, Canada, and to evaluate the impact of rheumatologist regional supply on access. METHODS We conducted a population-based retrospective study of all individuals diagnosed with RA between January 1, 2002 and December 31, 2019. Performance measures evaluated were: (i) percentage of RA patients seen by a rheumatologist within one year of diagnosis; and (ii) percentage of individuals with RA aged 66 years and older (whose prescription drugs are publicly funded) dispensed a disease modifying anti-rheumatic drug (DMARD) within 30 days after initial rheumatologist visit. Logistic regression was used to assess whether performance improved over time and whether the improvements differed by rheumatology supply, dichotomized as < 1 rheumatologist per 75,000 adults versus ≥1 per 75,000. RESULTS Among 112,494 incident RA patients, 84% saw a rheumatologist within one year: The percentage increased over time (adjusted odds ratio (OR) 2019 vs. 2002 = 1.43, p < 0.0001) and was consistently higher in regions with higher rheumatologist supply (OR = 1.73, 95% CI 1.67-1.80). Among seniors who were seen by a rheumatologist within 1 year of their diagnosis the likelihood of timely DMARD treatment was lower among individuals residing in regions with higher rheumatologist supply (OR = 0.90 95% CI 0.83-0.97). These trends persisted after adjusting for other covariates. CONCLUSION While access to rheumatologists and treatment improved over time, shortcomings remain, particularly for DMARD use. Patients residing in regions with higher rheumatology supply were more likely to access care but less likely to receive timely treatment.
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Affiliation(s)
- Claire E. H. Barber
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Ruth Croxford
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada
| | - Cheryl Barnabe
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Michal Abrahamowicz
- Arthritis Research Canada, Vancouver, BC Canada ,grid.14709.3b0000 0004 1936 8649Department of Epidemiology and Biostatistics, McGill University, Montreal, QC Canada
| | - Hui Xie
- Arthritis Research Canada, Vancouver, BC Canada ,grid.61971.380000 0004 1936 7494Faculty of Health Sciences, Simon Fraser University, Burnaby, BC Canada
| | - J. Antonio Avina-Zubieta
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - John M. Esdaile
- Arthritis Research Canada, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Glen Hazlewood
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada ,grid.22072.350000 0004 1936 7697Department of Community Health Sciences, University of Calgary, AB Calgary, Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB Canada ,Arthritis Research Canada, Vancouver, BC Canada
| | - Peter Faris
- grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, AB Canada
| | - Steven Katz
- grid.17089.370000 0001 2190 316XDepartment of Medicine, University of Alberta, Edmonton, AB Canada
| | - Paul MacMullan
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Dianne Mosher
- grid.22072.350000 0004 1936 7697Department of Medicine, University of Calgary, Calgary, AB Canada
| | - Jessica Widdifield
- grid.418647.80000 0000 8849 1617ICES, Toronto, Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Holland Bone and Joint Program, Sunnybrook Research Institute, Toronto, Canada
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Machado PM, Verschueren P, Grainger R, Jones H, Piercy J, van Beneden K, Caporali R, Dejaco C, Fautrel B. Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries. Rheumatol Adv Pract 2022; 7:rkac108. [PMID: 36601518 PMCID: PMC9800854 DOI: 10.1093/rap/rkac108] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective We aimed to describe, from the perspective of rheumatologists in Europe, how the coronavirus disease 2019 (COVID-19) pandemic has impacted their management of people with RA and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific ProgrammeTM in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour and continuing education owing to COVID-19. Results were summarized with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilization of video/telephone consultations (66.5% of respondents), fewer visits (58.5%) and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated that prescribing behaviour had changed switched their patients to self-administered medication, and 60.7% reported not starting patients on targeted synthetic DMARDs, biologic originator DMARDs or biosimilar DMARDs. In total, 57.6% of rheumatologists believed that changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusion All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to prepare better for future pandemics and to address ongoing rheumatologist shortages.
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Affiliation(s)
- Pedro M Machado
- Correspondence to: Pedro M. Machado, Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, 1st Floor, Russell Square House, 10–12 Russell Square, London WC1B 5EH, UK. E-mail:
| | | | - Rebecca Grainger
- Department of Medicine, University of Otago, Dunedin, New Zealand
| | - Hannah Jones
- Autoimmune Franchise, Adelphi Real World, Bollington, UK
| | - James Piercy
- Health Economics and Outcomes Research, Adelphi Real World, Bollington, UK
| | | | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy,Division of Clinical Rheumatology, ASST Pini-CTO, Milan, Italy
| | | | - Bruno Fautrel
- Service de Rhumatologie, Sorbonne Université-Assistance Publique-Hôpitaux de Paris, Paris, France
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Seppen BF, Verkleij SJ, Wiegel J, ter Wee MM, Nurmohamed MT, Bos WH. Probability of Medication Intensifications in Rheumatoid Arthritis Patients With Low Disease Activity Scores on Their Patient-Reported Outcomes: A Medical-Records Review Study. J Clin Rheumatol 2022; 28:397-401. [PMID: 35905459 PMCID: PMC9704811 DOI: 10.1097/rhu.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with rheumatoid arthritis require frequent consultations to monitor disease activity and intensify medication when treatment targets are not met. However, because most patients are in remission during follow-up, it should be possible to reduce the number of consultations for them. Electronic patient-reported outcomes (ePROs) could be used to identify patients who meet their treatment goal and who could therefore be eligible to skip their visit. OBJECTIVE The aim of this study was to assess the probability that patients with low disease activity scores on their ePROs do not need a disease-modifying antirheumatic drug (DMARD) or steroid intensification in the first 2 weeks after completion of the ePROs. METHODS This medical-records review study compared results of ePROs answered during routine care with DMARD or steroid intensifications collected from anonymized electronic medical record at Reade. The primary outcome was the positive predictive value (PPV) of having a low disease activity score on an ePRO for not receiving a DMARD or steroid intensifications within 2 weeks. The 3 studied ePROs (and respective low disease activity outcome) were the Routine Assessment of Patient Index Data 3 (RAPID3) (score <2), Patient Acceptable Symptom State (PASS) (yes), and the flare question (no). The secondary aim of the study was to assess which combination of ePROs resulted in the best PPV for DMARD or steroid intensifications. RESULTS Of the 400 randomly selected records, ultimately 321 were included (302 unique patients). The PPV of a RAPID3 <2, being in PASS, and a negative answer on the flare question were, respectively, 99%, 95%, and 83% to not receive a DMARD or steroid intensification within 2 weeks. The combination of a RAPID3 <2 and a negative flare question resulted in a PPV of 100%; this combination was present in 29% (93/321) of the total study population. CONCLUSION The RAPID3, PASS, and flare question have a high diagnostic accuracy to identify individuals who will not receive a DMARD or steroid intensification in the following 2 weeks. The combination of the RAPID3 and flare question yielded the best combination of diagnostic accuracy and highest percentage of patients who could be eligible to skip a visit. These results suggest that accurate identification of patients who meet their treatment goal with ePROs is possible.
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Affiliation(s)
| | | | - Jimmy Wiegel
- From the Reade Rheumatology
- Department of Rheumatology, Amsterdam UMC
| | - Marieke M. ter Wee
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Wouter H. Bos
- From the Reade Rheumatology
- Department of Rheumatology, Amsterdam UMC
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28
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Kuhlmann E, Bruns L, Hoeper K, Witte T, Ernst D, Jablonka A. [Health workforce development in rheumatology : A mapping exercise and wake-up call for health policy]. Z Rheumatol 2022; 81:717-729. [PMID: 34003376 PMCID: PMC8129704 DOI: 10.1007/s00393-021-01012-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Health workforce shortage in German rheumatology has been identified as a healthcare service and delivery problem. Health policy has increased staffing targets, yet effective intervention strategies are lacking. This research aimed to systematically map the rheumatology workforce to improve the evidence for interventions and explore possibilities for more effective health workforce management. METHODS The WHO National Health Workforce Accounts provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labor market flows, composition and education/training. A comparison of age groups and time series was applied to explore trends. Public statistics and other secondary sources served our analysis using descriptive methodology. RESULTS In Germany there are 1076 physicians specialized in internal medical rheumatology. Absolute numbers have nearly doubled (91%) since 2000 but with a strong demographic bias. Between 2000 and 2019 numbers markedly increased in the group aged 50 years and older but only by 9% in the younger group under 50 years; since 2010 the group aged 40-50 years even faces a decrease. In 2019, the absolute numbers of rheumatologists in retirement age exceeded those aged 40 years and under. Since 2015 an expanding workforce trend has overall flattened but this was strongest in the hospital sector; the numbers in resident training did not show any relevant growth. CONCLUSION Health workforce trends reveal that an available number of rheumatologists cannot meet new health policy planning targets. There is a need for effective health workforce management, focusing on innovation in resident training, improved task delegation and gender equality.
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Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
- Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover, Deutschland
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Seppen B, Wiegel J, ter Wee MM, van Schaardenburg D, Roorda LD, Nurmohamed MT, Boers M, Bos WH. Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial. Arthritis Rheumatol 2022; 74:1737-1745. [PMID: 35818342 PMCID: PMC9826407 DOI: 10.1002/art.42292] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/14/2022] [Accepted: 06/02/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We developed a smartphone application for patients with rheumatoid arthritis (RA) that allows them to self-monitor their disease activity in between clinic visits by answering a weekly Routine Assessment of Patient Index Data 3. This study was undertaken to assess the safety (noninferiority in the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate [DAS28-ESR]) and efficacy (reduction in number of visits) of patient-initiated care assisted using a smartphone app, compared to usual care. METHODS A 12-month, randomized, noninferiority clinical trial was conducted in RA patients with low disease activity and without treatment changes in the past 6 months. Patients were randomized 1:1 to either app-supported patient-initiated care with a scheduled follow-up consultation after a year (app intervention group) or usual care. The coprimary outcome measures were noninferiority in terms of change in DAS28-ESR score after 12 months and the ratio of the mean number of consultations with rheumatologists between the groups. The noninferiority limit was 0.5 difference in DAS28-ESR between the groups. RESULTS Of the 103 randomized patients, 102 completed the study. After a year, noninferiority in terms of the DAS28-ESR score was established, as the 95% confidence interval (95% CI) of the mean ΔDAS28-ESR between the groups was within the noninferiority limit: -0.04 in favor of the app intervention group (95% CI -0.39, 0.30). The number of rheumatologist consultations was significantly lower in the app intervention group compared to the usual care group (mean ± SD 1.7 ± 1.8 versus 2.8 ± 1.4; visit ratio 0.62 [95% CI 0.47, 0.81]). CONCLUSION Patient-initiated care supported by smartphone self-monitoring was noninferior to usual care in terms of the ΔDAS28-ESR and led to a 38% reduction in rheumatologist consultations in RA patients with stable low disease activity.
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Affiliation(s)
- Bart Seppen
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Jimmy Wiegel
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Marieke M. ter Wee
- Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Dirkjan van Schaardenburg
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, Academic Medical CenterAmsterdamThe Netherlands
| | | | - Michael T. Nurmohamed
- Reade Rheumatology, and the Department of RheumatologyAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
| | - Maarten Boers
- Reade Rheumatology, and the Department of Epidemiology and Data ScienceAmsterdam UMC, VU University Medical CenterAmsterdamThe Netherlands
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Frederiksen BA, Schousboe M, Terslev L, Iversen N, Lindegaard H, Savarimuthu TR, Just SA. Ultrasound joint examination by an automated system versus by a rheumatologist: from a patient perspective. Adv Rheumatol 2022; 62:30. [DOI: 10.1186/s42358-022-00263-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The Arthritis Ultrasound Robot (ARTHUR) is an automated system for ultrasound scanning of the joints of both hands and wrists, with subsequent disease activity scoring using artificial intelligence. The objective was to describe the patient’s perspective of being examined by ARTHUR, compared to an ultrasound examination by a rheumatologist. Further, to register any safety issues with the use of ARTHUR.
Methods
Twenty-five patients with rheumatoid arthritis (RA) had both hands and wrists examined by ultrasound, first by a rheumatologist and subsequently by ARTHUR. Patient-reported outcomes (PROs) were obtained after the examination by the rheumatologist and by ARTHUR. PROs regarding pain, discomfort and overall experience were collected, including willingness to be examined again by ARTHUR as part of future clinical follow-up. All ARTHUR examinations were observed for safety issues.
Results
There was no difference in pain or discomfort between the examination by a rheumatologist and by ARTHUR (p = 0.29 and p = 0.20, respectively). The overall experience of ARTHUR was described as very good or good by 92% (n = 23), with no difference compared to the examination by the rheumatologist (p = 0.50). All (n = 25) patients were willing to be examined by ARTHUR again, and 92% (n = 23) would accept ARTHUR as a regular part of their RA clinical follow up. No safety issues were registered.
Conclusions
Joint ultrasound examination by ARTHUR was safe and well-received, with no difference in PRO components compared to ultrasound examination by a rheumatologist. Fully automated systems for RA disease activity assessment could be important in future strategies for managing RA patients.
Trial registration: The study was evaluated by the regional ethics committee (ID: S-20200145), which ruled it was not a clinical trial necessary for their approval. It was a quality assessment project, as there was no intervention to the patient. The study was hereafter submitted and registered to Odense University Hospital, Region of Southern Denmark as a quality assessment project and approved (ID: 20/55294).
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Abstract
PURPOSE OF REVIEW We summarize the recent literature published in the last 2 years on healthcare disparities observed in the delivery of rheumatology care by telemedicine. We highlight recent research dissecting the underpinnings of healthcare disparities and identify potentially modifiable contributing factors. RECENT FINDINGS The COVID-19 pandemic has had major impacts on care delivery and has led to a pronounced increase in telemedicine use in rheumatology practice. Telemedicine services are disproportionately underutilized by racial/ethnic minority groups and among patients with lower socioeconomic status. Disparities in telemedicine access and use among vulnerable populations threatens to exacerbate existing outcome inequalities affecting people with rheumatic disease. SUMMARY Telemedicine has the potential to expand rheumatology services by reaching traditionally underserved communities. However, some areas lack the infrastructure and technology to engage in telemedicine. Addressing health equity and the digital divide may help foster more inclusive telemedicine care.
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Affiliation(s)
- Lesley E Jackson
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Wiegel J, Seppen BF, Ter Wee MM, Nurmohamed MT, Boers M, Bos WH. The RAPID3 questionnaire as a screening tool to reduce the number of outpatient clinic visits: a retrospective cohort study. Clin Rheumatol 2022; 41:2525-2531. [PMID: 35469354 PMCID: PMC9287255 DOI: 10.1007/s10067-022-06162-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
Background Treat-to-target strategies require frequent on-site evaluations of disease activity in patients with rheumatoid arthritis (RA), burdening patients and caregivers. However, this frequency may not be required in patients in a stable low disease activity state. The Routine Assessment of Patient Index Data 3 (RAPID3) is a reliable tool to detect such states in groups but has not been tested to reduce the frequency of on-site evaluations in individual patient care. In Reade, an outpatient rheumatology clinic, patients can complete the questionnaire online prior to consultation, and the results are directly fed into the electronic patient record. Focusing on low disease activity, we retrospectively studied the test characteristics of RAPID3 and its agreement with the DAS28 in our database of routine patient care. Objective To assess the test characteristics and agreement between de DAS28 and the RAPID3 in patients with RA, with a focus on the low disease activity categories. Methods We performed a retrospective database study with available clinical data collected as part of usual care from the electronic medical record at Reade Amsterdam. The dataset comprised RAPID3 assessments followed by a DAS28 within 2 weeks, obtained between June 2014 and March 2021. We dichotomized the disease activity categories for both the RAPID3 and DAS28 into low (remission and low disease activity) and high (moderate and high disease activity). With cutoff values of 2.0 for RAPID3 and 3.2 for DAS28, we calculated test characteristics and agreement (Cohen’s kappa). Results A total of 5009 combined RAPID3 and DAS28 measurements were done at Reade in 1681 unique RA patients. The mean age was 60 years, and 76% of patients were female with a median disease duration of 4 years. Agreement was considered fair (kappa = 0.26). In total, 1426 (28%) of the RAPID3 measurements were classified as low and could be potentially targeted to skip their consultations. The sensitivity to detect low disease activity was 0.39, specificity was 0.93, and the positive predictive value was 0.92. Conclusion We showed that when the RAPID3 classifies a patient into low disease activity state, the accuracy is 92%. Of all consultations, 28% could possibly be postponed following the screening with RAPID3.
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Affiliation(s)
- J Wiegel
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands.
- Amsterdam Rheumatology & Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands.
| | - B F Seppen
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands
- Amsterdam Rheumatology & Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - M M Ter Wee
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - M T Nurmohamed
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands
- Amsterdam Rheumatology & Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - M Boers
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands
- Amsterdam Rheumatology & Immunology Center, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
- Department of Epidemiology & Data Science, Amsterdam Public Health, Amsterdam UMC Location VUmc, Amsterdam, the Netherlands
| | - W H Bos
- Amsterdam Rheumatology & Immunology Center, Reade, Amsterdam, the Netherlands
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Kulhawy-Wibe SC, Widdifield J, Lee JJY, Thorne JC, Yacyshyn EA, Batthish M, Jerome D, Shupak R, Jilkine K, Purvis J, Shamis J, Roberts J, Kur J, Burt JE, Johnson NA, Barnabe C, Spencer N, Harrison M, Pope J, Barber CE. Results from the 2020 Canadian Rheumatology Association's Workforce and Wellness Survey. J Rheumatol 2022; 49:635-643. [DOI: 10.3899/jrheum.210990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/22/2022]
Abstract
Objective The Canadian Rheumatology Association (CRA) launched the Workforce and Wellness Survey to update the Canadian rheumatology workforce characteristics. Methods The survey included demographic and practice information, pandemic impacts, and the Mini-Z questionnaire to assess burnout. French and English survey versions were distributed to CRA members electronically between 10/14/2020-3/5/2021. The number of full-time equivalent (FTE) rheumatologists per 75,000 population was estimated from the median proportion of time in clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association (CMA). Results Forty-four percent (183/417) of the estimated practicing rheumatologists (149 adult; 34 pediatric) completed the survey. The median age was 47 years, 62% were female, and 28% planned to retire within the next 5-10 years. Respondents spent a median of 65% of their time in clinical practice. FTE rheumatologists per 75,000 ranged between 0 and 0.70 in each province/territory and 0.62 per 75,000 nationally. This represents a deficit of 1 to 78 FTE rheumatologists per province/territory and 194 FTE rheumatologists nationally to meet the CRA's workforce benchmark. Approximately half of survey respondents reported burnout (51%). Women were more likely to report burnout (OR 2.86, 95%CI: 1.42-5.93). Older age was protective against burnout (OR 0.95, 95%CI: 0.92, 0.99). As a result of the pandemic, 97% of rheumatologists reported spending more time engaged in virtual care. Conclusion There is a shortage of rheumatologists in Canada. This shortage may be compounded by the threat of burnout to workforce retention and productivity. Strategies to address these workforce issues are urgently needed.
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Intriago M, Maldonado G, Soriano E, Toro C, Moreno L, Ríos C. Burnout in Rheumatologists in Latin America. J Clin Rheumatol 2022; 28:1-6. [PMID: 34670993 DOI: 10.1097/rhu.0000000000001795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Rheumatology is considered a low-risk specialty, but studies have shown a prevalence of burnout between 42% and 51%. OBJECTIVES The aim was to determine the prevalence of burnout in rheumatologists in Latin America and the factors associated with it. METHODS Cross-sectional study based on a survey completed through Google Forms platform that was sent by the national rheumatology associations of Latin America. Burnout was assessed with the Maslach Burnout Inventory. Data were analyzed using the statistical program SPSS v.22. RESULTS Two hundred ninety-seven rheumatologists from 15 countries were included, mainly Argentina (28.3%), Brazil (26.3%), and Mexico (12.8%). The majority were women 62%, 42.4% worked in public hospitals with an average of 40.1 ± 14.2 hours per week; 31.3% did research, 13.1% clinical trials, 56.6% teaching, and 42.8% administrative work; 36% received an annual income less than $25,000; 56.6% had burnout in at least 1 dimension. Only 20.2% thought they had burnout, 9.1% were currently receiving professional help, and 15.8% had sought help in the past; 72.1% said they were willing to participate in a program to reduce burnout. The rheumatologists with burnout were younger than those without burnout (46.5 vs 49.9 years, p = 0.015). CONCLUSIONS Burnout affects near half of rheumatologists in Latin America and was associated with younger age, long working hours, low satisfaction, less happiness, higher Patient Health Questionnaire-9, suicidal thoughts, anxiety, income, presence of comorbidities, and low self-esteem.
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Affiliation(s)
- Maria Intriago
- From the Jackson Memorial Hospital, University of Miami, Miami, FL
| | | | | | - Carlos Toro
- Centro de Referencia en Osteoporosis y Reumatología, Cali, Colombia
| | - Letty Moreno
- Centro de Reumatología y Rehabilitación, Guayaquil
| | - Carlos Ríos
- Universidad Espiritu Santo, Samborondón, Ecuador
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Mucke J, Knitza J, Muehlensiepen F, Grahammer M, Stenzel R, Simon D, Kleyer A, Krönke G, Sharp C, Bendzuck G, Korinth M, Elling-Audersch C, Vuillerme N, Schett G, Pecher AC, Krusche M. TELERA-Asynchronous TELEmedicine for Patients With Rheumatoid Arthritis: Study Protocol for a Prospective, Multi-Center, Randomized Controlled Trial. Front Med (Lausanne) 2021; 8:791715. [PMID: 34966765 PMCID: PMC8710736 DOI: 10.3389/fmed.2021.791715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022] Open
Abstract
Innovative strategies are needed to adequately assess and monitor disease activity of patients with rheumatoid arthritis (RA) in times of scarce appointments. The aim of the TELERA study is to evaluate the feasibility and performance of asynchronous telemedicine visits based on patient-generated data and patient's drug history. RA patients use a medical app, ABATON, that captures the results of a self-performed quick CRP-test, joint-count, and electronic patient-reported outcomes in between visits. This is a prospective, multi-center, randomized controlled trial performed in four German university centers. The estimated sample size is 120 patients. The main outcome is the agreement of rheumatologists' treatment decisions based on asynchronous telemedicine patient-generated data with traditional in-person rheumatology clinic-based decisions and with patient suggestions. The TELERA trial will provide evidence regarding the implementation of remote care in rheumatology. Clinical Trial Registration: This clinical trial was registered at German Registry for Clinical Trials (DRKS). http://www.drks.de/DRKS00016350, identifier: DRKS00024928.
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Affiliation(s)
- Johanna Mucke
- Policlinic and Hiller Research Unit for Rheumatology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Johannes Knitza
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum, Erlangen, Germany
- Université Grenoble Alpes, AGEIS, Grenoble, France
| | - Felix Muehlensiepen
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Ruedersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | | | - Ramona Stenzel
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum, Erlangen, Germany
| | - Gerhard Krönke
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum, Erlangen, Germany
| | - Charlotte Sharp
- Centre for Epidemiology Versus Arthritis, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom
| | | | | | | | - Nicolas Vuillerme
- Université Grenoble Alpes, AGEIS, Grenoble, France
- LabCom Telecom4Health, Orange Labs and Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
- Institut Universitaire de France, Paris, France
| | - Georg Schett
- Department of Internal Medicine Rheumatology and Immunology, Friedrich-Alexander- University Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), FAU Erlangen-Nuremberg and Universitätsklinikum, Erlangen, Germany
| | - Ann-Christin Pecher
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases, University Hospital Tuebingen, Tübingen, Germany
| | - Martin Krusche
- Division of Rheumatology and Inflammatory Rheumatic Diseases, University Hospital Hamburg Eppendorf, Hamburg, Germany
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Muehlensiepen F, Knitza J, Marquardt W, May S, Krusche M, Hueber A, Schwarz J, Vuillerme N, Heinze M, Welcker M. Opportunities and Barriers of Telemedicine in Rheumatology: A Participatory, Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413127. [PMID: 34948737 PMCID: PMC8701397 DOI: 10.3390/ijerph182413127] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/14/2022]
Abstract
Despite all its promises, telemedicine is still not widely implemented in the care of rheumatic and musculoskeletal diseases (RMDs). The aim of this study is to investigate opportunities, barriers, acceptance, and preferences concerning telemedicine among RMD patients and professional stakeholders. From November 2017 to December 2019, a participatory, mixed-methods study was conducted, consisting of (1) expert interviews (n = 27) with RMD patients and professional stakeholders, (2) a national paper-based patient survey (n = 766), and (3) focus groups (n = 2) with patient representatives and rheumatologists. The qualitative findings indicate that patients equate personal contact with physical face-to-face contact, which could be reduced by implementing telemedicine, thus negatively influencing the patient–doctor relationship. Correspondingly “no personal contact with the doctor” is the main reason (64%) why 38% of the surveyed patients refuse to try telemedicine. Professional stakeholders expect telemedicine to contribute to the effective allocation of scarce resources in rheumatology care. The main barriers reported by stakeholders were the scarcity of time resources in RMD care, the absence of physical examinations, and organizational challenges associated with the implementation of telemedicine in RMD care. While the exact integration of telemedicine into routine care has yet to be found, the consequences on the patient-physician relationship must be permanently considered.
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Affiliation(s)
- Felix Muehlensiepen
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Correspondence:
| | - Johannes Knitza
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
- Deutsches Zentrum für Immuntherapie, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Wenke Marquardt
- KV Consult-und Managementgesellschaft mbH, 14469 Potsdam, Germany;
| | - Susann May
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
| | - Martin Krusche
- Department of Internal Medicine III, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany;
| | - Axel Hueber
- Division of Rheumatology, Klinikum Nürnberg, Paracelsus Medical University, 90419 Nürnberg, Germany;
| | - Julian Schwarz
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Nicolas Vuillerme
- AGEIS, Université Grenoble Alpes, 38000 Grenoble, France; (J.K.); (N.V.)
- Institut Universitaire de France, 75006 Paris, France
- LabCom Telecom4Health, Orange Labs & Université Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, 38400 Grenoble, France
| | - Martin Heinze
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, 15562 Rüdersdorf bei Berlin, Germany; (S.M.); (M.H.)
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany
- Department of Psychiatry and Psychotherapy, Brandenburg Medical School Theodor Fontane, Immanuel Klinik Rüdersdorf, 15562 Rüdersdorf, Germany;
| | - Martin Welcker
- Medizinisches Versorgungszentrum für Rheumatologie Dr. M. Welcker GmbH, 82152 Planegg, Germany;
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Kuhlmann E, Bruns L, Hoeper K, Richter M, Witte T, Ernst D, Jablonka A. Work situation of rheumatologists and residents in times of COVID-19 : Findings from a survey in Germany. Z Rheumatol 2021; 82:331-341. [PMID: 34535820 PMCID: PMC8448391 DOI: 10.1007/s00393-021-01081-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 11/28/2022]
Abstract
Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks. Supplementary Information The online version of this article (10.1007/s00393-021-01081-5) includes the survey questionnaire in German.
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Affiliation(s)
- Ellen Kuhlmann
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Luzia Bruns
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kirsten Hoeper
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Marianne Richter
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.,Regionales Kooperatives Rheumazentrum Niedersachsen e. V., Hannover , Germany
| | - Torsten Witte
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Diana Ernst
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Alexandra Jablonka
- Klinik für Rheumatologie und Immunologie, Medizinische Hochschule Hannover, OE 6830, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Krusche M, Knitza J, Burmester GR. Train to target - How we might learn in the future. Joint Bone Spine 2020; 88:105126. [PMID: 33524766 DOI: 10.1016/j.jbspin.2020.105126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Martin Krusche
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany.
| | - Johannes Knitza
- Department of Internal Medicine 3, Friedrich-Alexander-Universitat Erlangen-Nurnberg, Erlangen, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité- Universitätsmedizin, Berlin, Germany
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Abstract
Gout is the most common inflammatory arthritis in the US, affecting 3.9% of the population. Although many effective gout therapies are available for acute flares and chronic management, it is suboptimally treated worldwide, and recurrent gout flares can cause significant pain and irreversible joint damage.
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