Telemedicine for Patients with Systemic Lupus Erythematosus in a Publicly Funded Hospital System: A Retrospective Study.

ABSTRACT

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that requires frequent clinic and laboratory visits. However, patients with SLE, particularly those that are under-resourced, have unacceptably high rates of no-shows. OBJECTIVE: The objective of this study was to determine no-show rates associated with telemedicine visits during the COVID-19 pandemic in comparison to no show rates associated with contemporaneous and historic in-person. METHODS: We performed a retrospective cohort study in a publicly funded county hospital system in Houston, Texas. We identified a cohort of established SLE patients by International Classification of Diagnosis (ICD) codes that were independently confirmed as SLE by review of medical records. We identified patients who were seen from March to December in 2018, 2019, and 2020 (to reflect the height of the COVID-19 pandemic and account for seasonal changes in disease activity). Our primary outcome was percentage of no-shows for rheumatology clinic appointments. Our secondary outcome was laboratory utilization adherence, which was defined as lupus-specific blood and urine studies conducted within 30 days of the scheduled appointment. Covariates included age, gender, race, ethnicity, and SLE-related prescription drugs. RESULTS: We included 156 SLE patients in our analysis. Most were female (90.4%), Hispanic (49.3%) and had a median age of 43. In 2020, the no-show rate for telemedicine was 5.5% compared to a no-show rate of 16.2% for in-person visits (p=0.002). After multivariable adjustment for covariates, the odds of no-show was lower for telemedicine visits (OR 0.39, 95% CI 0.20-0.77). There were no differences in adherence to laboratory testing. CONCLUSIONS: Telemedicine visits had decreased odds of no-shows without difference in laboratory testing adherence after adjustment for covariates. More research is needed to determine the clinical impact of telemedicine on patients with SLE.