RESUMO
BACKGROUND: The use of telemedicine in pediatric rheumatology has been historically low. The current COVID 19 global pandemic has forced a paradigm shift with many centers rapidly adopting virtual visits to conduct care resulting in rapid expansion of use of telemedicine amongst practices. BODY: This commentary discusses practical tips for physicians including guidance around administrative and governance issues, preparation for telemedicine, involving the multidisciplinary care team, and teaching considerations. We also outline a standard proforma and smart phrases for the electronic health record. A proposed variation of the validated pediatric gait arms legs spine examination (pGALS) called the video pGALS (VpGALS) as a means of conducting virtual pediatric rheumatology physical examination is presented. CONCLUSION: This commentary provides a starting framework for telemedicine use in pediatric rheumatology and further work on validation and acceptability is needed.
Assuntos
Infecções por Coronavirus , Pandemias , Pediatria/métodos , Exame Físico/métodos , Pneumonia Viral , Reumatologia/métodos , Telemedicina/métodos , Comunicação por Videoconferência , Betacoronavirus , COVID-19 , Atenção à Saúde , Europa (Continente) , Humanos , Seleção de Pacientes , Pediatria/educação , Pediatria/organização & administração , Reumatologia/educação , Reumatologia/organização & administração , SARS-CoV-2 , Telemedicina/legislação & jurisprudência , Telemedicina/organização & administração , Estados UnidosRESUMO
BACKGROUND: Due to a limited number and disparate distribution of pediatric rheumatologists in the US, a variety of physician types provide care to children with rheumatologic diseases. However, little is known about how that care may differ across prescribing physician groups. Our objective was to compare medication claims for children with juvenile idiopathic arthritis (JIA) by type of prescribing physician. METHODS: We performed a retrospective cohort study of children with JIA using Michigan Medicaid data for 7/1/2005-6/30/2007, employing descriptive and bivariate analyses by age, medication type, and prescriber type. RESULTS: Among 397 children, there was no difference in the frequency of medication claims for children with internist versus pediatric rheumatologist prescribers. Children with non-rheumatologist prescribers were less likely to have claims for disease modifying anti-rheumatic drugs (DMARDs) and biologic agents. CONCLUSION: Differential use of DMARDs and biologic agents by rheumatologists indicates the importance of referring children with JIA for specialty care.