Impact of telemedicine on visit attendance for paediatric patients receiving endocrinology specialty care

Background Children in rural communities often lack access to subspecialty medical care. Telemedicine has the potential to improve access to these services but its effectiveness has not been rigorously evaluated for paediatric patients with endocrine conditions besides diabetes. Introduction The purpose of this study was to assess the association between telemedicine and visit attendance among patients who received care from paediatric endocrinologists at an academic medical centre in northern California between 2009–2017. Methods We abstracted demographic data, encounter information and medical diagnoses from the electronic health record for patients ≤18 years of age who attended at least one in-person or telemedicine encounter with a paediatric endocrinologist during the study period. We used a mixed effects logistic regression model – adjusted for age, diagnosis and distance from subspecialty care – to explore the association between telemedicine and visit attendance. Results A total of 40,941 encounters from 5083 unique patients were included in the analysis. Patients who scheduled telemedicine visits were predominantly publicly insured (97%) and lived a mean distance of 161 miles from the children’s hospital. Telemedicine was associated with a significantly higher odds of visit attendance (odds ratio 2.55, 95% confidence interval 2.15–3.02, p < 0.001) compared to in-person care. Conclusions This study demonstrates that telemedicine is associated with higher odds of visit attendance for paediatric endocrinology patients and supports the conclusion that use of telemedicine may improve access to subspecialty care for rural and publicly insured paediatric populations.

Incidence of disorders of sexual development in neonates in Ghana: prospective study

ObjectiveThe incidence of disorders of sexual development (DSD) is unknown in sub-Saharan Africa. We describe the characteristics and incidence of DSD in a cohort of infants born in Ghana.DesignTrained research assistants performed systematic genital examination at birth. All infants with suspected abnormal genitalia were further examined by a paediatric endocrinologist.SettingKomfo Anokye Teaching Hospital, Kumasi, Ghana.PatientsConsecutive infants born in a single centre over a 1-year period (May 2014 to April 2015).Main outcome measuresIncidence of DSD. Micropenis was defined as a stretched length <2.1 cm and clitoromegaly as a clitoral length >8.6 mm.ResultsWe examined 9255 infants (93% of all live births) within 72 hours of birth. Twenty-six neonates had a DSD. Nineteen infants had DSD without genital ambiguity: isolated micropenis (n=2), hypospadias (n=7), cryptorchidism (n=4) and clitoromegaly (n=6). Seven infants had DSD with ambiguity: clitoromegaly with a uterus on ultrasound and elevated 17-hydoxyprogesterone, suggesting XX DSD due to congenital adrenal hyperplasia (CAH)(n=4) and micropenis, hypospadias and gonads in a bifid scrotum or in the inguinal region, consistent with XY DSD (n=3).ConclusionThe incidence of atypical genitalia was 28/10,000 (95% CI 17/10 000 to 39/10 000) live births. The incidence of CAH was 4.3/10 000 (95% CI 1.2/10 000 to 11.1/10 000) and was strongly associated with consanguinity.

Vaccination and diabetes mellitus type 1 in children

Influence of vaccination on the risk of developing diabetes mellitus type 1 (DM1) has been studied by different researchers for several decades. In rodents, vaccination can prevent development of DM1. This review summarises existing literature and discusses the results of a 2016 meta-analysis, pertaining to vaccination and DM1. No vaccines appear to increase the risk of DM1. Additional investigations are needed to determine if vaccines can be considered protective against DM1. Patients with DM1 are at increased risk of morbidities from controllable infections. Children with DM1 should receive regularly-scheduled vaccinations; choice of vaccines and inoculation with non-regular vaccines should be determined on an individual basis. We present basic principles surrounding vaccination in patients with DM1 and analyse the role of the paediatric endocrinologist in increasing vaccination uptake in children with DM1.

DEFINING PEDIATRIC DIABETES USING EMR RECORDS AND VALIDATION FROM LINKABLE MANITOBA COHORT DATA

BACKGROUND The prevalence of paediatric diabetes is increasing. Identifying and describing populations with paediatric diabetes using Primary Care Electronic Medication Records (EMR) can improve surveillance and management. OBJECTIVES To describe the population of children diagnosed with paediatric diabetes in Manitoba using Electronic Medical Record data from Community Paediatricians and Family Physcians in Manitoba. DESIGN/METHODS We applied a previously validated case definition for type 1 and type 2 diabetes to patients aged 1–18 seen by one of the 221 primary care providers participating in the Manitoba Primary Care Research Network (MaPCReN) between 1998–2015. We compared the agreement between the MaPCReN definition and Manitoba’s Diabetes Education Resource for Children and Adolescents (DERCA) clinical database of confirmed cases. Cases were described, including prevalence, patient characteristics, and health system use. RESULTS Our definition identified 166 children (0.4%, 95% CI 0.36% - 0.49%) of whom 53.0% lived in a rural location and 53.6% were female. The mean age at diagnosis was 11.4 years (SD 5.4). There were 90 patients identified by the definition also cared for by a paediatric endocrinologist at DERCA [sensitivity (54.2%), specificity (98.7%), and kappa (0.61, CI 0.54-.069)]. An additional 286 patients had at least one documented HbA1C of 6.5% or higher but did not have a corresponding diabetes diagnosis within the EMR. Of those, 45% had an HbA1c between 6.5 -7.5 and 25.9% had an HbA1c over 8.5%. Most of these patients also had an abnormal fasting glucose in the EMR (76.9%). There were 280 patients with an elevated HbA1c that had no evidence of attending an appointment with a paediatric endocrinologist at DERCA, 70.8% have a rural address. CONCLUSION The inclusion of HbA1c values in identifying paediatric diabetes suggested a large number of patients without a corresponding diabetes diagnosis or record of care from DERCA. Therefore, the DERCA database might be underestimating the true prevalence of diabetes in Manitoba. Understanding further characteristics of this population, is an essential step to inform the development of enhanced services and strategies.