Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice

Shenoi, Susan; Hayward, Kristen; Curran, Megan L.; Kessler, Elizabeth A.; Mehta, Jay; Riebschleger, Meredith; Foster, Helen

doi:10.1186/s12969-020-00476-z

Cited by 31 publications

(28 citation statements)

References 15 publications

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“…Similarly, a study of adult and pediatric patients from a single center in New York City early in the pandemic found that 40% of patients reported experiencing a flare in the prior month and that patients reported experiencing anxiety when coming in for routine or urgent visits regarding their rheumatic conditions (46). New guidance has been provided to improve telemedicine assessments, including standardizing the musculoskeletal physical exam using the video version of pGALS, V‐pGALS (47). With rapidly improving technology, the use of telemedicine will likely persist beyond the pandemic to maintain full access to clinical care.…”

Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

Wahezi

Rubinstein

et al. 2021

Arthritis & Rheumatology

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Objective. To provide clinical guidance to rheumatology providers who treat children with pediatric rheumatic disease (PRD) in the context of the coronavirus disease 2019 (COVID-19) pandemic.Methods. The task force, consisting of 7 pediatric rheumatologists, 2 pediatric infectious disease physicians, 1 adult rheumatologist, and 1 pediatric nurse practitioner, was convened on May 21, 2020. Clinical questions and subsequent guidance statements were drafted based on a review of the queries posed by the patients as well as the families and healthcare providers of children with PRD. An evidence report was generated and disseminated to task force members to assist with 3 rounds of asynchronous, anonymous voting by email using a modified Delphi approach. Voting was completed using a 9-point numeric scoring system with predefined levels of agreement (categorized as disagreement, uncertainty, or agreement, with median scores of 1-3, 4-6, and 7-9, respectively) and consensus (categorized as low, moderate, or high). To be approved as a guidance statement, median vote ratings were required to fall into the highest tertile for agreement, with either moderate or high levels of consensus.Results. To date, 39 guidance statements have been approved by the task force. Those with similar recommendations were combined to form a total of 33 final guidance statements, all of which received median vote ratings within the highest tertile of agreement and were associated with either moderate consensus (n = 5) or high consensus (n = 28).Conclusion. These guidance statements have been generated based on review of the available literature, indicating that children with PRD do not appear to be at increased risk for susceptibility to SARS-CoV-2 infection. This guidance is presented as a "living document," recognizing that the literature on COVID-19 is rapidly evolving, with future updates anticipated.Due to the rapidly expanding information and evolving evidence related to COVID-19, which may lead to modification of some guidance statements over time, it is anticipated that updated versions of this article will be published, with the version number included in the title. Readers should ensure that they are consulting the most current version.Guidance developed and/or endorsed by the American College of Rheumatology (ACR) is intended to inform particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to this guidance to be voluntary, with the ultimate determination regarding its application to be made by the physician in light of each patient's individual circumstances. Guidance statements are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidance developed or endorsed by the ACR is subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.

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Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

Wahezi

Rubinstein

et al. 2021

Arthritis & Rheumatology

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“…The instrument also may not be able to identify small effusions or detect active joints in young children when used over telemedicine. Recently, Shenoi et al ( 30 ) proposed the Video-pGALS (an adapted version of the pGALS), but this has not been validated and was created using input from a small group of pediatric rheumatologists. Additional research needs to be undertaken to determine whether this tool can accurately assess joint disease activity in a virtual setting.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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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.

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“…Telemedicine offers a plausible solution [ 32 ]. Recently, there has been increased access to and reliance on remote meeting systems [ 33 ]. Tele-consults through platforms such as zoom can be used to enhance multi-disciplinary care for patients.…”

Section: The Current State Of Pediatric Rheumatology In Africamentioning

confidence: 99%

“…Further research is required to explore how best to utilize telemedicine to promote pediatric rheumatology in Africa. In solidarity with global partners, researchers from Africa are participating in the validation of the virtual pediatric gait, arms, leg, spine (PGALS) screening examination as part of a global telemedicine initiative [ 33 ]. More research is needed to explore the feasibility of telemedicine for pediatric rheumatology in Africa.…”

Section: The Current State Of Pediatric Rheumatology In Africamentioning

confidence: 99%

Pediatric rheumatology in Africa: thriving amidst challenges

Migowa¹,

Hadef

Hamdi

et al. 2021

Pediatr Rheumatol

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Background Pediatric Rheumatology is an orphan specialty in Africa which is gradually gaining importance across the continent. Main body This commentary discusses the current state of affairs in the sphere of Pediatric Rheumatology across Africa and offers practical strategies to navigate the challenges encountered in research, models of care, education and training. We outline the establishment, opportunities of growth and achievements of the Pediatric Society of the African League Against Rheumatism (PAFLAR). Conclusion This commentary lays the foundation for establishment of a formidable framework and development of partnerships for the prosperity of Pediatric Rheumatology in Africa and beyond.

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Telemedicine in pediatric rheumatology: this is the time for the community to embrace a new way of clinical practice

Cited by 31 publications

References 15 publications

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

American College of Rheumatology Guidance for the Management of Pediatric Rheumatic Disease During the COVID‐19 Pandemic: Version 2

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

Pediatric rheumatology in Africa: thriving amidst challenges

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