Background:Telemedicine counseling (TMC) has gained rapid development during the COVID-19 pandemic. The prospect of using this technology in rheumatology was based on the possibility of getting maximum information about the patient during the survey, examination and interpretation of laboratory and instrumental data, that is excepting direct contact with the patient. Several rheumatological clinics have reported on the success of using TMC. However, there is very little data of the difficulties that can be encountered when organizing this process.Objectives:To characterize the identified problems during TMC in rheumatology, to suggest potential directions for their elimination.Methods:Since June 2021, on the basis of the Medical Association “New Hospital”, Yekaterinburg, Russian Federation, 76 TMCs have been performed on the profile of rheumatology in patients aged 29 to 71 years. Of these, 13 applied to the primary TMC, the other patients were preliminarily examined in person. The consultation included the preliminary acquaintance with the examination results, a 20-minute video communication and writing of a conclusion. After each TMC, a survey was conducted between the doctor and the patient, including the identified deficiencies in counseling. The frequency of identified problems is presented as an absolute indicator and as a percentage of the total number of TMCs performed.Results:We noted a high degree of patient satisfaction: 74 (97.4%) responded that they received answers to all. However, according to the doctor, the following groups of problems were identified.[1]Technical problems in 29 (38.2%): most often there were various problems with the Internet, but there were also registered: the end of the charge on the patient’s tablet, the patient was not registered in the electronic queue. Elimination of these violations depends on the work of IT-specialists, but each consulting physician should be prepared for an immediate transition to an alternative form of communication (for example - telephone).[2]Lack of objective examination, leading to the impossibility of correct remote diagnosis - 8 (10.5%). This problem was identified due to the inability to establish the presence or absence of arthritis during the initial diagnosis (6 cases) and to clarify the nature of the rash (2 cases). All patients are invited for a face-to-face consultation.[3]The need to write prescriptions for psychotropic drugs - 12 (15.8%), which under the conditions of national legislation cannot be done in the TMC regime.[4]The time spent directly on remote communication with the patient was 17.2 minutes (from 8 to 31), however, taking into account the study data and writing the conclusion, the total time was 40.7 minutes (from 21 to 73). Thus, it turned out that the average time for remote and face-to-face consultations is the same, while TMC’s payment is only about 50% of the face-to-face consultation. This situation reduces the doctor’s interest in carrying out TMC. The solution to the problem is associated with reducing the time for the documentation process through technical improvements. In addition, of the 9 patients in whom the TMC process lasted 60 minutes or more, 5 were diagnosed with fibromyalgia. It is possible that with a previously established diagnosis of fibromyalgia, only face-to-face counseling should be recommended to patients.Conclusion:The TMC system is promising, however, there are a number of problems that need to be improved, since they can reduce the doctor’s interest in using this technology.Disclosure of Interests:None declared
The training of obstetric physicians and nurses to change the obstetric model in Brazil: A view of the preceptors in the training process
