Lee Kong Chian School of Medicine, Nanyang Technological University.
Department of Medicine, Yong Loo Lin School of Medicine.
Rheumatology (Oxford). 2022 May 5;61(5):1911-1918. doi: 10.1093/rheumatology/keab694.
Despite the widespread adoption of teleconsultations amid the COVID-19 pandemic, their safety in SLE patients has not been evaluated. Here, we examined subsequent disease activity and flares among SLE patients who received teleconsultation vs in-person consultation. To discern differences in physicians' prescription behaviour during both forms of consultations, we compared corticosteroid dose adjustments.
We studied adult SLE patients who were seen between 1 February 2020 and 1 February 2021. At each patient-visit, rheumatologists utilized phone/video teleconsultation or physical consultation at their discretion. Disease activity was assessed with SLE Disease Activity Index 2000 (SLEDAI-2K) and flares were defined by the SELENA-SLEDAI Flare Index (SFI). We derived a propensity score for patients who were chosen for physical consultation. Multivariable generalized estimation equations were used to analyse SLEDAI-2k and flare at the next visit, adjusted for the propensity score.
A total of 435 visits were recorded, of which 343 (78.9%) were physical visits and 92 (21.1%) were teleconsultations. The modality of consultation did not predict flare [OR for physical consultation (95% CI) 0.42 (0.04, 5.04), P =0.49] or SLEDAI-2k at the next visit [estimate of coefficient for physical consultation (95% CI) -0.19 (-0.80, 0.43), P =0.55]. Adjustments of prednisolone dosages were comparable between the two forms of visits [OR for physical consultation (95% CI) 1.34 (0.77, 2.34), P =0.30].
SLE disease activity and flares at the subsequent visit were similar between teleconsultations and physical consultations. Medication prescription behaviour, determined using adjustment in corticosteroid dosages, was not different between the two forms of visits.
尽管在 COVID-19 大流行期间广泛采用了远程咨询，但尚未评估其在系统性红斑狼疮（SLE）患者中的安全性。在这里，我们检查了接受远程咨询和面对面咨询的 SLE 患者随后的疾病活动和发作情况。为了辨别两种咨询形式下医生处方行为的差异，我们比较了皮质类固醇剂量的调整。
我们研究了 2020 年 2 月 1 日至 2021 年 2 月 1 日期间就诊的成年 SLE 患者。在每次就诊时，风湿病医生可以自行选择电话/视频远程咨询或体格检查。使用系统性红斑狼疮疾病活动指数 2000 版（SLEDAI-2K）评估疾病活动，根据 SELENA-SLEDAI 发作指数（SFI）定义发作。我们为选择体格检查的患者得出了倾向评分。使用多变量广义估计方程分析下一次就诊时的 SLEDAI-2k 和发作，调整倾向评分。
共记录了 435 次就诊，其中 343 次（78.9%）为体格就诊，92 次（21.1%）为远程咨询。咨询方式并未预测发作[体格就诊的优势比（95%CI）0.42（0.04，5.04），P=0.49]或下一次就诊时的 SLEDAI-2K[体格就诊的系数估计值（95%CI）-0.19（-0.80，0.43），P=0.55]。两种就诊形式下泼尼松龙剂量的调整相似[体格就诊的优势比（95%CI）1.34（0.77，2.34），P=0.30]。
远程咨询和体格咨询后 SLE 的疾病活动和发作情况相似。两种就诊形式下，药物处方行为（通过皮质类固醇剂量调整来确定）没有差异。
