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Abstract Number: 103

Rheumatology e-Consult Services:  a Rheumatology Workforce Management Model

Thomas Schmidt1, Charles Lappan2 and Daniel Battafarano3, 1Rheumatology, SAUSHEC/ Brooke Army Medical Center, San Antonio, TX, 2United States Army, San Antonio, TX, 3Rheumatology, San Antonio Military Medical Center, JBSA - Ft Sam Houston, TX

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: consults, management and rheumatologic practice, Workforce

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Session Information

Title: Health Services Research

Session Type: Abstract Submissions (ACR)

Background/Purpose: The regional distribution of adult rheumatologist in the United States (U.S.) was recently analyzed by the American College of Rheumatology (ACR)1.   Regional workforce shortages were recognized with suggested options to address this concern.  Electronic digital consultation (e-Consult) is one proposed solution.   An e-Consult service was implemented by the U.S. Army to assist providers in remote global areas. 

Methods: A retrospective analysis of rheumatology e-Consults from May of 2006 to May of 2014 was performed. Military providers from all services submitted consultation requests via a secure email site with digital file attachments.  Patient identifiable information was excluded.  A total of 24 rheumatology staff and fellows provided e-Consult services, and a program manager monitored and aggregated data for rheumatology.  Collaboration with other e-Consult services was available and facilitated through the program manager.

Results:  A total of 193 rheumatology e-Consults were processed.  The average response time was 5.3 hours with 98% answered within 24 hours.   There were 122 requests (63%) from Iraq and Afghanistan. Diagnoses included: inflammatory arthritis (65; 22 polyarticular, 18 RA, 14 gout, 8 infectious, 3 monoarticular), seronegative spondyloarthropathy (27; 9 psoriatic arthritis, 6 reactive, 6 undifferentiated, 1 inflammatory bowel disease), arthralgias/myalgias (24), elevated CPK (8), lupus (7; 4 SLE, 2 discoid, 1 pernio), Raynaud’s phenomenon (7),  mechanical pain (7),  positive ANA (6), sicca syndrome (4), DM (1) and 37 other.  e-Consult collaboration was common and primarily with dermatology (29) and infectious disease (13). 

Conclusion: Over an 8-year period an Army rheumatology e-consult service successfully assisted remote providers with diagnosis and management of rheumatic diseases.  This global, collaborative model provided timely subspecialty care and input to providers that did not have immediate access to a rheumatologist.   A similar digital and collaborative management model may facilitate rheumatology support for non-rheumatologists in underserved or remote areas.

1.            American College of Rheumatology Committee on Rheumatology T, Workforce I, FitzGerald JD, et al. Regional distribution of adult rheumatologists. Arthritis and rheumatism. Dec 2013;65(12):3017-3025.


Disclosure:

T. Schmidt,
None;

C. Lappan,
None;

D. Battafarano,
None.

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