Specifics of the telemedicine in patients with paraproteinemic hemoblastoses

Abstract

Background. Medical care through telemedicine technologies for plasma cell tumors has been provided at the National Medical Research Center for Hematology since 2018. Patients are consulted at the “doctor–doctor” level in the field of “hematology”. Another important aspect of the application of telemedicine at the National Medical Research Center for Hematology is scientific, practical and educational activities aimed at developing remote interaction with medical institutions, developing ways to improve interaction with specialized medical organizations.Aim. To present the implementation of the main applications of telemedicine technologies on the example of paraproteinemic hemoblastoses.Materials and methods. From October 2018 to October 2022 the department of hematology and chemotherapy of paraproteinemic hemoblastoses with bone marrow and hematopoietic stem cells transplantation unit of National Medical Research Center for Hematology received 815 telemedicine requests (701 – primary, 114 – repeated). In 93.6 % of cases, telemedicine consultation was required for multiple myeloma, 2.6 % of requests included information about patients with solitary plasmacytoma, in individual cases, regional hematologists made inquiries about patients with plasma cell leukemia, plasmablastic lymphoma, Waldenstrom’s macroglobulinemia.Results. There has been an annual increase in the number of telemedicine consultations for multiple myeloma. Of the 73 participating regions, the most active were: Tambov Region, Altai Territory, Vladimir Region, Republic of Crimea, Republic of Buryatia, Krasnodar Territory, and Krasnoyarsk Territory. Most of the consultations are aimed at clarifying the tactics of treating multiple myeloma. In 20 % and 22 % of cases, first- and second-line therapy was recommended. In response to 21 % of requests, recommendations were given for the treatment of multiple myeloma complicated by double and triple refractoriness. In 14 % of requests, insufficient information content of medical documentation did not allow expressing an adequate opinion on the tactics of patient management. Hospitalization at the National Medical Research Center for Hematology for the purpose of autologous hematopoietic stem cells transplantation was recommended in 10 % of cases. An analysis of 4 % of telemedicine requests testified to the expediency of palliative treatment and local radiation therapy at the place of residence. The main disadvantages of requests are the lack of primary information when establishing a diagnosis and information on disease monitoring during therapy, as well as the presence of excessive information in medical records.Conclusion. An analysis of telemedicine consultations for paraproteinemic hemoblastoses over a 4‑year period indicates a high need for regional hematologists to discuss therapy tactics with doctors from the federal center. Through telecommunications between doctors of National Medical Research Center for Hematology and the region, in some cases, the full range of diagnostic and therapeutic measures is ensured, which contributes to improving the quality of medical care.