POS1480-HPR IMPLEMENTATION OF TELEMEDICINE IN RHEUMATOLOGY: VIRTUAL CONSULTATION AS A TOOL FOR DIRECT COMMUNICATION WITH PRIMARY CARE

Abstract

Background:Virtual consultation is defined as the provision of a healthcare service when there is a distance between the subjects and information and communication technologies are used to carry out the consultation. This tool has been successfully implemented in different specialties. It is useful for providing quick solutions, improving the overload of the medical care and for the early detection of inflammatory diseases1. In our centre, virtual consultation from Primary Care (PC) to Hospital Care (HC) has been implemented.Objectives:The main objective is to describe our experience with the use of virtual consultation and its value as a new modality of specialised medical care. The second aim is to identify the most frequent reasons for consultation and diagnoses, to assess the concordance between the two and to analyse the trend over time of the number of virtual consultations and their relationship with the different waves of the COVID 19 pandemic.Methods:Retrospective observational study. The virtual consultations made from PC (47 centres) to Rheumatology during 2020 were analysed. They were carried out through a computer programme, using the “Andalusian Health Service Virtual Consultation Platform” tool. A specific agenda was established for virtual consultations. The reason for the referral and the rheumatologist’s diagnosis were collected. The response given to the PC was divided into four models: NON-TRIBUTARY (not related to the speciality), DISCHARGE (a diagnosis and therapeutic response is concluded), APPOINTMENT FOR CONSULTATION and FOLLOW-UP (new contact is requested, completing the information). The reasons for consultation, diagnoses, time and type of response were analysed.Results:47 virtual consultations were carried out. 54.5% (n 298) were closed as DISCHARGE. 27.4% (n 150) were APPOINTMENT FOR CONSULTATION, and 17.7% (n 97) indicated FOLLOW-UP. Only 0.4% (n 2) were NOT TRIBUTARY.The average response time was 2 days 15 hours and 56 min.The most frequent reason for consultation was polyarthralgias (26.7%, n 146) and after the rheumatologist’s assessment a diagnosis was established in 89% of them. Inflammatory arthropathy accounted for 30.8% (n 45), osteoarthritis for 19.9% (n 29), fibromyalgia for 12.3% (n 18), polymyalgia rheumatica (PMR) for 6.9% (n 10), osteoporosis for 2.7% (n 4) and connective tissue disease for 2.1% (n 3).Another frequent reason for consultation was osteoporosis (13.5% n 74), of which 85.1% (n 63) had a confirmed diagnosis and/or need for revision.A diagnosis could be made via telematics in 89.6% of the consultations. 15.5% were osteoporosis (n 85), 14.9% osteoarthritis (n 81), 10.5% soft tissue injuries, 8.8% mechanical/nonspecific pain (n 47), 7.1% rheumatoid arthritis (n 39), 6.5% fibromyalgia (n 34), 6.2% connective tissue disease (n 34), 5.7% PMR (n 31), 4.9% suspected spondyloarthritis (n 26), 4.2% psoriatic arthritis (n 23) and 4.2% microcrystalline arthritis (n 23).27.4% (n 150) of the virtual consultations were required for assessment in a face-to-face appointment. We analysed the distribution over time (Figure 1). In the COVID 19 confinement phase (14 March - 21 June), the number of consultations increased, peaking in June, a behaviour that has persisted in the other mobility phases (October/November).Conclusion:More than half of the virtual consultations carried out were resolved without face-to-face assessment, with a diagnosis being established in almost 90%. It is an effective tool for rapid access to Rheumatology, detecting pathology requiring preferential attention, with a face-to-face appointment, as well as for the early diagnosis of inflammatory arthropathy, which was detected in a quarter of the consultations, as well as for the diagnosis and follow-up of osteoporosis. Virtual consultation facilitates a quick response, playing an even more relevant role in the current SARS CoV-2 pandemic situation.