Date of Award

9-16-2010

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Lisa G. Suter, MD

Second Advisor

Paul McCarthy, MD

Third Advisor

Thomas Carpenter, MD

Abstract

ACCEPTANCE OF TELEMEDICINE IN PEDIATRIC RHEUMATOLOGY: A NATIONAL SURVEY OF PEDIATRICIANS. Kathleen Jo E. Corbin, Lisa G. Suter. Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT. The specific aims of this study were to characterize: 1) the impact of the pediatric rheumatology workforce shortage from the perspective of pediatric rheumatologists and general pediatricians, and 2) the acceptance of telemedicine, including both video conferencing and store and forward technology, as a potential solution for the pediatric rheumatology workforce shortage. We hypothesized that physicians practicing in settings with decreased access to pediatric rheumatology would perceive a greater impact of the workforce shortage and would be more likely to accept telemedicine as a substitute for face-to-face patient care. A web-based survey was distributed to members of the American Academy of Pediatrics (AAP) Section on Rheumatology, American College of Rheumatology Section on Pediatric Rheumatology, and a geographically representative sample of AAP state chapters. In addition to responses from 141 pediatric rheumatologists and 613 general pediatricians, we also received responses from 140 other pediatric subspecialists. Rheumatologists were significantly more likely than general pediatricians and other subspecialists to report that the workforce shortage adversely affected their patients (79.2% vs. 61% and 42.2%, respectively; all p<0.001). Delay of diagnosis was identified as one of the most important consequences of the workforce shortage by 64.5% of rheumatologists, 43.7% of general pediatricians, and 30% of other subspecialists. Rheumatologists and general pediatricians practicing in predominantly rural states were more likely than those in urban states to report their patients were affected by the workforce shortage (90.9% vs. 73.5%, p=0.039 for rheumatologists, 71.6% vs. 46.6%, p=0.001 for general pediatricians). A minority of rheumatologists, general pediatricians, and other subspecialists accepted video conferencing as a substitute for face-to-face patient care for routine new (23.4% vs. 30.8% vs. 25%, respectively), routine follow-up (31.2% vs. 38.5% vs. 37.1%, respectively), and urgent visits (34% vs. 35.7% vs. 35.7%, respectively). Similarly, a minority of all respondents accepted store and forward telemedicine as a substitute for face-to-face patient care. In multivariable analysis adjusting for technology use, number of years in practice, and concern about liability, general pediatricians practicing in predominantly rural states were significantly more likely to accept video conferencing (e.g. OR 1.70, 95% CI 1.16-2.48 for new visits). For rheumatologists and general pediatricians, concern about liability was significantly negatively associated with acceptance of video conferencing (e.g. OR 0.43, 95% CI 0.23-0.80 and OR 0.68, 95% CI 0.52-0.90, respectively for new visits) as well as store and forward telemedicine (e.g. OR 0.35, 95% CI 0.14-0.87 and OR 0.54, 95% CI 0.38-0.76, respectively for new visits). Open-ended responses highlighted the need for experienced examiners at the remote end of telemedicine consultations as well as the potential educational value of telemedicine. Our data suggest that telemedicine would best be utilized for the care of children with rheumatic diseases in under-resourced areas, either for urgent triage decision-making or in the context of multidisciplinary care to allow for communication and education with both providers and parents. In addition, telemedicine cannot be effectively adopted on a large-scale basis until liability concerns regarding remote care are addressed.

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