Date: Monday, October 22, 2018
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Twenty-five pediatric rheumatologists (PR) service a population of 14 million Ontarians. To facilitate care to patients living in distance communities we proposed a new model of care using a local Advanced Clinician Practitioners in Arthritis Care (ACPAC) to engage with PRs via telemedicine. The first phase of this project reported our needs assessment of patients seen in London and Toronto. Of a total of 265 patient/caregiver respondents, 80% of patients travelled > 50 km with 13% travelling > 200 km with an associated cost >$50 in 37% and ≥1 missed day of work in 56% to attend PR visits. We present preliminary results from the second phase of this project: a survey of patient/parent satisfaction in attending an ACPAC-PR telehealth clinic visit.
Methods: Twenty-five ACPACs interested in additional pediatric rheumatology training attended a two-day training program occurred in September 2016. Of the four ACPAC therapists participating in the pilot clinic phase, 3 had extensive pediatric experience and fourth received on-site training. Patient/caregiver perception of visit burden and satisfaction of the ACPAC-PR telehealth visit were surveyed. Quantitative data were summarized using descriptive statistics and qualitative data were analyzed using grounded theory.
Results: Four telehealth clinics in both Windsor ACPAC-London PR (28 visits, 20 unique patients) and Thunder Bay ACPAC–Toronto PR (18 unique patient visits) have occurred to date. 19/23 surveys were returned from the Windsor-London clinic and 12/18 distributed at the Thunder Bay-Toronto site. 26/31 (84%) travelled < 25 km to the clinic. 21/31 (68%) spent <$ 25 on travel with 32% spending nothing. 12/45 (27%) of parents/guardians missed 1/2 to 1 full day of work with no one missing more than 1 day. >90% of respondents strongly agreed/agreed that they were satisfied with the telemedicine process and interaction with the ACPAC and PRs. 30/31 (96%) indicated that “the care I received today was equal to the care I receive in person” and that the wait time to see the PR was adequate (versus too short or too long) compared with an in person visit (87%).
Conclusion: A model of care integrating ACPACs, telemedicine and PRs improves local access to pediatric rheumatology care while reducing the burden of travel and cost to families. Barriers to the full implementation of this model include the lack of funding for ACPACs to provide these outreach clinics as well as lack of (pediatric) ACPACs in distant communities to sustainably provide this valuable service.
To cite this abstract in AMA style:Berard R, MacQueen S, Diebold M, Goh YI, MacLeod A, Whitney-Mahoney K, O'Brien C, Feldman BM, Levy DM. A New Model of Care for Pediatric Rheumatology in Ontario: Preliminary Results from Pilot Telemedicine Clinics Utilizing Advanced Clinician Practitioners in Arthritis Care [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/a-new-model-of-care-for-pediatric-rheumatology-in-ontario-preliminary-results-from-pilot-telemedicine-clinics-utilizing-advanced-clinician-practitioners-in-arthritis-care/. Accessed September 16, 2021.
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