Goh Y Ingrid, Bullock Danielle R, Taylor Janalee, Pooni Rajdeep, Lee Tzielan C, Vora Sheetal S, Yildirim-Toruner Cagri, Morgan Esi M, Pan Nancy, Harris Julia G, Warmin Andrew, Wiegand Kendra, Burnham Jon M, Barbar-Smiley Fatima
Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada.
Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada.
Front Pediatr. 2021 Mar 4;9:642460. doi: 10.3389/fped.2021.642460. eCollection 2021.
Healthcare providers were rapidly forced to modify the way they practiced medicine during the coronavirus disease 2019 (COVID-19) pandemic. Many providers transitioned from seeing their patients in person to virtually using telemedicine platforms with limited training and experience using this medium. In pediatric rheumatology, this was further complicated as musculoskeletal exams typically require hands-on assessment of patients. The objective of this study was to examine the adoption of telemedicine into pediatric rheumatology practices, to assess its benefits and challenges, and to gather opinions on its continued use. A survey was sent to the lead representatives of each Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) site to collect data about their center's experience with telemedicine during the COVID-19 pandemic. Quantitative data were analyzed using descriptive statistics, and qualitative data were thematically analyzed. Responses were received from the majority [19/21 (90%)] of PR-COIN sites. All respondents reported transitioning from in-person to primarily virtual patient visits during the COVID-19 pandemic. All centers reported seeing both new consultations and follow-up patients over telemedicine. Most centers reported using both audio and video conferencing systems to conduct their telemedicine visits. The majority of respondents [13/19 (68%)] indicated that at least 50% of their site's providers consistently used pediatric Gait Arms Legs and Spine (pGALS) to perform active joint count assessments over telemedicine. Over half of the centers [11/19 (58%)] reported collecting patient-reported outcomes (PROs), but the rate of reliably documenting clinical components varied. A few sites [7/19 (37%)] reported performing research-related activity during telemedicine visits. All centers thought that telemedicine visits were able to meet providers' needs and support their continued use when the pandemic ends. Benefits reported with telemedicine visits included convenience and continuity of care for families. Conversely, challenges included limited ability to perform physical exams and varying access to technology. Pediatric rheumatology providers were able to transition to conducting virtual visits during the COVID-19 pandemic. Healthcare providers recognize how telemedicine can enhance their practice, but challenges need to be overcome in order to ensure equitable, sustainable delivery of quality and patient-centered care.
在2019年冠状病毒病（COVID-19）大流行期间，医疗服务提供者迅速被迫改变他们的行医方式。许多提供者在使用远程医疗平台方面培训和经验有限的情况下，从亲自看诊患者转变为主要通过虚拟方式使用远程医疗平台。在儿科风湿病领域，这一情况更加复杂，因为肌肉骨骼检查通常需要对患者进行亲自评估。本研究的目的是调查远程医疗在儿科风湿病实践中的采用情况，评估其益处和挑战，并收集关于其持续使用的意见。向每个儿科风湿病护理与结局改善网络（PR-COIN）站点的主要代表发送了一份调查问卷，以收集他们中心在COVID-19大流行期间使用远程医疗的经验数据。定量数据使用描述性统计进行分析，定性数据进行主题分析。收到了PR-COIN站点大多数[19/21（90%）]的回复。所有受访者都报告在COVID-19大流行期间从亲自看诊转变为主要进行虚拟患者就诊。所有中心都报告通过远程医疗接待了新的会诊患者和随访患者。大多数中心报告使用音频和视频会议系统进行远程医疗就诊。大多数受访者[13/19（68%）]表示，他们站点至少50%的提供者持续使用儿科步态、手臂、腿部和脊柱（pGALS）在远程医疗中进行主动关节计数评估。超过一半的中心[11/19（58%）]报告收集了患者报告的结局（PROs），但可靠记录临床成分的比例各不相同。一些站点[7/19（37%）]报告在远程医疗就诊期间开展了与研究相关的活动。所有中心都认为远程医疗就诊能够满足提供者的需求，并支持在大流行结束后继续使用。远程医疗就诊报告的益处包括为家庭提供便利和护理的连续性。相反，挑战包括进行体格检查的能力有限以及技术获取情况各异。儿科风湿病提供者在COVID-19大流行期间能够转变为进行虚拟就诊。医疗服务提供者认识到远程医疗如何能够提升他们的实践，但为了确保公平、可持续地提供高质量和以患者为中心的护理，仍需克服挑战。
