Abstract
Objective: To investigate the factors associated with telemedicine (TM) use for follow-up of Systemic Lupus Erythematous (SLE) patients in the COVID-19 pandemic.Methods: This was a single-centered cross-sectional study conducted in Hong Kong. Consecutive patients followed up at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM in the form of videoconferencing. The demographic, socioeconomic, and disease data of the first 140 patients opted for TM and 140 control patients preferred to continue standard in-person follow-up were compared.Results: The mean age of all the participants was 45.6 ± 11.8 years, and the disease duration was 15.0 ± 9.2 years. The majority of them were on prednisolone (90.0%) and immunosuppressants (67.1%). The mean SLEDAI-2k was 3.4 ± 2.4, physician global assessment (PGA) was 0.46 ± 0.62 and Systemic Lupus International Collaborating Clinics (SLICC) damage index was 0.97 ± 1.23. A significant proportion of the patients (72.1%) had 1 or more comorbidities. It was found that patients with higher mean PGA (TM: 0.54 ± 0.63 vs. control: 0.38 ± 0.59, p = 0.025) and family monthly income > USD 3,800 (TM: 36.4% vs. control: 23.6%; p = 0.028) preferred TM, while full-time employees (TM: 40.0% vs. control: 50.7%; p = 0.041) preferred in-person follow-up. These predictors remained significant in the multivariate analysis after adjusting for age and gender. No other clinical factors were found to be associated with the preference of TM follow-up.Conclusion: When choosing the mode of care delivery between TM and physical clinic visit for patients with SLE, the physician-assessed disease activity and patient's socio-economic status appeared to be important.
Highlights
Since coronavirus disease 2019 (COVID-19) was declared a pandemic, the rapidly increasing number of cases and deaths overwhelmed the health care system worldwide
All participants were asked to complete a set of questionnaires including the LupusQoL, Health Assessment Questionnaire Disability Index (HAQ-DI), and Hospital Anxiety and Depression Scale (HADS)
The socio-economic status of the patients was collected through questionnaire which has been used in studies of local patients with autoimmune rheumatic diseases [17, 18]
Summary
Since coronavirus disease 2019 (COVID-19) was declared a pandemic, the rapidly increasing number of cases and deaths overwhelmed the health care system worldwide. Patients with SLE are at heightened risk of infection due to the underlying disease and the use of immunosuppressive therapies [1]. During this extraordinary time, lupus patients face the difficult choice between risking COVID-19 exposure during a clinician visit and postponing needed care. Patients with SLE typically require regular follow-up (FU) visits to ensure early detection of flares and to monitor the toxicity of immunosuppressive therapy. The use of TM to reduce potential exposure to COVID-19 has been recommended by international rheumatology societies [6, 7]. Specific statements on the scope and limitations of the use of video consultations in rheumatology patients have been published [9]
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