Caring for pediatric patients during a pandemic requires adapting health delivery services to address the physical and psychosocial needs of children and caregivers in an environment of heightened stress. Jay Mehta, MD, chair of the ACR Pediatric Rheumatology Special Committee and attending physician in the Division of Rheumatology, Children’s Hospital of Philadelphia, spoke with The Rheumatologist about how his clinic is adapting to the COVID-19 pandemic.
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Q: How is your clinic adapting to the changes brought on by COVID-19?
We pivoted very quickly to telehealth. Within a few weeks, we saw nearly 100% of our regular outpatient volume using telehealth, with a few exceptions for patients we felt needed to be seen in the clinic—potential new diagnosis or suspected flare, for example. We are able to still deliver pretty good care through telehealth, even though it’s no substitute for in-person visits. For many patients, especially those who have been doing well for a long period of time—patients on stable medications with stable disease—we are able to accomplish close to what we do in person.
Q: What barriers are you seeing with adapting to telehealth?
We’re using a telehealth application that is embedded in our electronic medical record system. Initially it worked 70% of the time; about 30% of the time, calls would drop, patients couldn’t see us or we couldn’t see them, the audio wasn’t good, or we could hear but not see patients. In cases where it doesn’t work, we have to decide whether or not to bring the patient in for a clinic visit.
Another challenge is that telehealth requires a stable wi-fi connection, and not all of our families are fortunate enough to afford high-speed internet.
A further challenge is getting kids to cooperate during exams. In the clinical setting, we can be creative in how we get kids to squat down or walk, or whatever it is we ask them to do. Over telehealth, it can be challenging. When seeing teenagers, we typically ask the parents to leave the room so we can first talk to the teenager, but over telehealth it is hard to know if the parent has actually left the room.
On the provider side, there was a learning curve. We had to learn how to do musculoskeletal assessments over telehealth. We found that pGALS, or Pediatric Gait, Arms, Legs and Spine, works pretty well. It’s a screening test that a patient can do on their own, and we can watch them via video to look for signs, such as limited movement or pain, that may indicate arthritis, for example. Other things are more difficult over telehealth, such as detecting rashes or examining the oral cavity, or impossible, such as feeling lymph nodes or the liver.