Background/Purpose: Nearly 1 in 250 children live with arthritis, yet less than 300 board certified, practicing pediatric rheumatologists exist in the United States, approximately 90% of whom are located in large cities. Clinic travel can be a significant time and monetary commitment for families. Telemedicine (TM) may improve patient access to pediatric rheumatology (PR) clinics and reduce the cost of care. The objective of this study is to describe the cost to families associated with PR visits and identify interest in TM.

Methods: Surveys were offered to parents and patients aged 18 or older in PR clinics in Kansas City, Missouri (KC) and at a TM outreach site 160 miles away, in Joplin, Missouri. Survey questions included the distance traveled to the appointment, amount of work and school missed, meal and lodging costs, and interest in a TM clinic. Joplin patients were asked to answer the survey questions in relation to appointments located currently in Joplin as well as previously in KC. Statistical analyses were conducted on patients seen in KC (n=256) and Joplin (n=24), as well as on a subsample of the KC respondents living at least 50 miles from the KC clinic. Different survey versions resulted in a variable number of total responses for each question. Descriptive and inferential analyses were performed using SPSS 20 and SAS 9.4, including chi-square and Wilcoxon rank sum tests for categorical and continuous variables, respectively.

Results: At the main KC clinic, the median distance traveled one-way was 41 miles [IQR=20-82]. Sixty-one percent of respondents missed work for the appointment, 52% purchased meals and 6% spent money on lodging. Overall, 42% were interested in a TM option. When stratified by distance, respondents living at least 50 miles from the KC clinic were more interested in TM than those less than 50 miles away (63% vs. 28%,  p<0.0001). Among respondents who missed work, those who spent more hours away from work were more likely to endorse interest in TM (p=0.004). The number of hours of school missed and amount of money spent were not associated with increased interest in TM.

In the Joplin sample, the median distance traveled was 60 miles [IQR=20-85] when seen via TM vs. 175 miles [IQR=160-200] when seen in KC (p<0.0001). Thirty-eight percent spent money on food related to the TM visit in contrast to 92% with a KC visit (p<0.0001). Joplin respondents were more likely to spend money collectively on food, lodging and/or child care when traveling to KC as compared to Joplin (92% vs. 38%, p<0.0001). Respondents missed an average of 5.5 ± 3.4 hours of work when seen in TM vs. 8.7 ± 1.6 hours when traveling to KC (p=0.018). Patients missed a mean of 4.8 ± 2.8 hours of school when seen via TM in Joplin compared to 8.4 ± 2.3 hours for an appointment in KC (p=0.001).

Conclusion: Children with rheumatic diseases often travel substantial distances to receive subspecialty care and incur significant costs with this travel. Interest in TM is associated with greater distance traveled and more time away from work. In our established TM Joplin clinic, respondents were less likely to spend money on travel, food, and lodging as well as time away from work and school.  TM is an effective way to lessen financial burden for families that travel considerable distances for PR care.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cost-savings-and-interest-in-pediatric-rheumatology-telemedicine-visits/