Most Pediatric Rheumatology Providers Find Telehealth Lacking for Clinical Assessment

Nearly 66% of pediatric rheumatology providers reported that telehealth visits were inadequate for complete clinical assessments, while 35.8% found their level of burnout had increased due to telehealth, according to survey results.

The results, published in Pediatric Rheumatology, are from a survey developed and administered by the Childhood Arthritis and Rheumatology Research Alliance (CARRA), to its members, during the COVID-19 pandemic in June and July 2020.

“Due to the recent pandemic and accompanying telehealth policy changes, the volume and attitudes around telemedicine have been shifting,” Rajdeep Pooni, MD, of Stanford Children’s Health, at the Stanford University School of Medicine, in Palo Alto, California, and colleagues wrote.

“Pediatric rheumatologists are faced with multiple issues in health care delivery and availability and a few reports have begun to explore telemedicine within this specialty in regard to patient acceptability along with cost and time effectiveness.”

“With the rapid implementation of telemedicine over the previous several months, there is a unique opportunity to evaluate telemedicine use in the pediatric rheumatology setting,” they added.

“Recent pediatric studies have described the ability to deploy telemedicine rapidly during the COVID-19 pandemic, however, few studies have described the potential benefits and clinical limitations from the subspecialists’ perspective during this time.”

To analyze telehealth use among pediatric rheumatology providers, as well as their views on its acceptability and reliability, during the COVID-19 pandemic, Pooni and colleagues worked with CARRA to develop and disseminate an electronic survey. The questionnaire was sent to a total of 547 members of the CARRA list, of whom 223 agreed to participate.

Among the respondents, 71.6% were pediatric rheumatologists, 16.4% were fellow trainees, and the remainder were other professionals, including nurse practitioners and researchers. Participants reported a mean 13.3 years of experience in practice, ranging from 0 to 48 years.

The researchers analyzed the survey results using descriptive statistics, while other trends were assessed using one-way ANOVA tests in SAS University Edition.

According to the researchers, participants rated musculoskeletal components as the most reliable part of a telehealth exam, with 86.5% of respondents reporting that they have engaged a patient or patient caregiver to help conduct the virtual exam. However, 65.7% of responders reported that telehealth exams failed to provide all of the information necessary to make a complete clinical assessment.

The researchers also noted areas of disagreement regarding patient engagement and confidentiality. In addition, 35.8% of those surveyed felt that their level of burnout was increased due to telemedicine.

“This is the first professional organization-wide study that captures a large cohort of pediatric rheumatologists and their experience regarding telemedicine use in their day-to-day practice during the COVID-19 pandemic,” Pooni and colleagues wrote.

“We found that in general, providers felt that components of the musculoskeletal exam were able to be done reliably through telemedicine, yet interestingly the majority of providers felt that they were not able to generate a complete clinical assessment.”

“This study was completed during what has been a very stressful time for individuals and the hospital systems they operate within; follow-up work, particularly around the above findings, is key as telemedicine becomes incorporated into routine rheumatologic practice,” they added.

“These survey findings only begin to uncover the complexities of telemedicine care in rheumatology and further in-depth qualitative, patient-facing, and outcomes-focused work is needed in order to develop standardized telemedicine approaches to pediatric rheumatologic care.”