Background/Purpose: The coronavirus disease 2019 (COVID-19) pandemic caused a widespread and emergent use of telemedicine outpatient visits to avoid patient exposure to the SARS-CoV-2 virus. Telemedicine may have the benefit of improving missed appointment by making clinic visits more accessible, especially in patients of low socioeconomic status. We completed a retrospective cohort study in patients with systemic lupus erythematosus (SLE) of low socioeconomic status managed at a county system hospital in Houston, TX.

Methods: We performed a retrospective analysis of SLE patients in the Harris Health System (HHS), a fully integrated healthcare system that provides care to residents of Harris County, Texas. This patient population has 87% of patients who are uninsured or have public insurance. We identified established patients with SLE (seen at least once by rheumatology prior to enrollment in the cohort) who were seen between September and November both in 2019 (pre-COVID-19) and 2020 (during pandemia). The primary outcome was missed clinic visit appointments. The secondary outcome was successful laboratory testing utilization, defined as complete blood count, comprehensive metabolic panel, urine studies, complements, and anti-double stranded DNA within 30 days before or after each completed visit. As patients may have had visit appointments in multiple years, we performed generalized estimate equations (GEEs) to adjust for this, along with multivariable logistic regression models to adjust for covariates (age, gender, race, ethnicity, and utilization of SLE-related prescribed drugs at the initial visit in the period).

Results: 157 patients were included. Most were female (90.4%), Hispanic (49.3%), and had a median age of 43. Our analysis included 771 in-person visits and 182 telemedicine visits. Patients who had telemedicine visits were more likely to be older and prescribed mycophenolate mofetil and glucocorticoids. The no-show rate for in-person visits in 2020 was 16.2% versus 5.5% for telemedicine (p = 0.002). After multivariable adjustment, there was a significantly decreased odds of no-shows for telemedicine versus in-person clinic appointments (Odds Ratio (OR) 0.39, 95% CI 0.20-0.77), which also persisted in a subgroup analysis of patients seen at least once in 2019 and 2020 (OR 0.31, 95 CI 0.14-0.69). We also found that telemedicine visits were associated with increased utilization of urine tests compared to in-person visits (97.3% versus 86.9%, p< 0.001). Utilization for other laboratory studies, including a composite outcome, was similar for both types of visits.

Conclusion: In conclusion, this study shows that the use of telemedicine during the initial phase of the COVID-19 pandemic was associated with a low rate of missed appointments without affecting laboratory utilization. Telemedicine may be a potential strategy to improve continuity of care amongst patients with SLE, especially those with socioeconomic and access to healthcare barriers.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/use-of-telemedicine-in-patients-with-systemic-lupus-erythematosus-in-a-publicly-funded-hospital-system/