Authors (including presenting author) :
So H(1)(2), Chow E(1), Cheng IT(1), Lau SL(1), Li TK(1), Szeto CC(1)(2), Tam LS(1)(2)
Affiliation :
1. Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
2. Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
Introduction :
It is important to weigh the infection risk of doctor visits against the risk of missing disease controls in patients with lupus nephritis during the COVID-19 outbreak. Telemedicine (TM) follow-up is a reasonable option. Despite the recent exponential increase in application worldwide, there is no study examining the clinical factors associated with TM use in patients with lupus nephritis.
Objectives :
In this study, we aimed to examine the clinical predictors for the preference of TM follow-up in patients with lupus nephritis.
Methodology :
Consecutive patients followed at the lupus nephritis clinic were contacted for their preference in changing the coming consultation to TM. The demographic, socioeconomic, psychological, disease and treatment data of the first 140 patients opted for TM and 140 patients preferred to continue standard in-person follow-up were collected and compared. They also completed a questionnaire on their perception about TM.
Result & Outcome :
The mean age of the 280 recruited patients was 45.6 ± 11.8 years. The mean disease duration was 15.0 ± 9.2 years. The majority of them had lupus nephritis class III, IV or V (88.2%) and were on prednisolone (90.0%). Two-third of the patients (67.1%) were on immunosuppressants. The mean SLEDAI-2k was 4.06 ± 2.54, physician global assessment (PGA) 0.46 ± 0.62 and SLICC/ACR damage index 1.11 ± 1.36. A significant proportion of the patients (72.1%) had one or more comorbidities. Higher PGA and family monthly income > HKD30,000 were found to be associated with TM use, while fulltime employment was related to the preference of in-person follow-up. These factors remained significant after controlling for age in the multivariate analysis with odd ratios for PGA 1.05 (95% CI 1.01-1.09), family income > HKD30,000 1.90 (95% CI 1.24-3.79) and fulltime employment 0.53 (95% CI 0.32-0.88). PGA was noted to be positively correlated with the perceptions that TM reduces (r=0.13, p=0.036) and routine visit increases (r=0.12, p=0.04) the risk of COVID-19 during the outbreak. To conclude, when choosing the mode of care delivery between TM and clinic visit, the patient’s disease activity as well as employment and economic status appeared to be important.
