Telemedicine for Inborn Errors of Immunity in Colombian patients: Pilot Study

Abstract

IntroductionInborn Errors of Immunity (IEI) are genetic diseases that affect the immune system. Telehealth is revolutionized clinical services around the world allowing remote access with technology that delivers care at a distance The University of Antioquia in Medellin (Colombia) initiated Telehealth in 2013 (Livinglab) and is currently one of the most advanced digital hospitals in Latin America. ObjectiveTo implement a tele-health service in immunology for Colombian patients with suspected IEI using the platform of Livinglab. MethodsA cross-sectional, observational, descriptive study was designed for patients with suspected IEI referred by different medical specialties. Synchronous telehealth consultations were carried out by remote videolink, by two immunologists and a general practitioner. A standardized patient approach was used to evaluate patients. Demographic and clinical characteristics, IEI diagnostic and treatments prescribed were collected. Descriptive statistics were used for quantitative analysis of all variables. ResultsSeventy-two patients were attended between May and November of 2022. Forty-four (61%) were female. Patients were from rural (65%) or urban (35%) areas. The medical specialties that most frequently referred patients were pediatrics, pneumology and infectious diseases. Main reasons for referral included: infections (79%), autoimmunity (7%), and allergies (4%).Main clinical findings in patients were infections (97%), followed by allergies (32%), and autoimmune manifestations (3%). The diagnosis of IEI was established in 24% of patients while in 27%, the diagnosis of an IEI was discarded; 50% remain under suspicion and are being followed up actively. The most frequent diagnosis was predominantly antibody deficiency 16 (94%) and only 10% have molecular and genetic characterization. Nineteen percent of patients are under immunoglobulin therapy. No major technical difficulties were encountered during the study. ConclusionThe use of telehealth in immunology was effective as a tool to identify Colombian patients with IEI. Our results show that this tool can be implemented for this specialty in Colombia and other countries with physical barriers that limit access to health care in remote as well as urban areas.