E044 Telephone clinic consultations in the COVID-19 era: the rates of conversion to face-to-face appointments and discharges in the post-pandemic years
Authors: Ramli Adlan Wafi , Ong Xian Hue , Chitale Sarang , Chelliah Easwaradhas Gladston 
Published: April 2023

Abstract

Background/Aims
It is vital to evaluate the implementation of telephone clinic (TEL) consultations since the COVID-19 pandemic began. We investigated the rates of conversion to face-to-face reviews (F2F) and discharges following a TEL consultation in our department, including the factors influencing these outcomes in 2 different years.

Methods
Patients who attended TEL consultations in April 2021 and March 2022 were retrospectively reviewed. Factors associated with conversion to F2F and discharges were identified using multivariate logistic regression analyses, adjusting for age and sex.

Results
578 patients included [314 (2022) vs 264 (2021)]; 69% female (both years) with similar median ages [63 (2022) vs 65 years (2021)]. The most common diagnosis was rheumatoid arthritis [39% (2022) vs 54% (2021)]. The rate of conversion to F2F was lower in 2022 (15.3% vs 29.9%). In 2021, multivariate analyses found that a consultant’s review was associated with a conversion to F2F [adjusted odds ratio (aOR) 2.22 95% CI (1.26, 3.90) P-value=0.005] whereas an SPN’s (specialist nurse) review was associated with a reduced likelihood [aOR 0.48 (0.28, 0.82) P-value=0.008]. In contrast, an SPN’s review in 2022 was associated with a conversion to F2F [aOR 2.02 (1.07, 3.90) P-value=0.032]. Other factors associated with F2F appointments in 2022 were current steroids [aOR 3.44 (1.63, 7.14) P-value&lt;0.001] and conventional DMARD therapy [aOR 3.14 (1.60, 6.55) P-value=0.001]. The rate of TEL discharges was higher in 2022 (8.9% vs 5.7%). In 2022, a consultant’s review was associated with discharges [aOR 4.07 (1.83, 9.53) P-value&lt;0.001] whereas an SPN’s review has a lower likelihood of discharges [aOR 0.04 (0.00, 0.17) P-value=0.001]. These associations were not identified in 2021. In both years, patients with inflammatory arthritis and on conventional DMARDs have a reduced likelihood of being discharged.

Conclusion
The lower rate of conversion to F2F and increased rate of discharges in 2022 suggest a higher level of confidence among clinicians in undertaking telephone consultations as they become more experienced. Patient factors such as diagnoses and current treatment influenced the decision regarding F2F appointments and/or discharges, as expected. In 2021, SPNs might have a higher threshold to request a F2F appointment as clinical services have been recovering since the pandemic began. As TEL reviews became more commonplace in 2022, their threshold may have been subsequently lowered. The increased likelihood of conversion to F2F following a consultant’s review in 2021 suggests a higher incidence of flare-ups as remote consultations were increasing. In terms of discharges in 2022, the differences between consultants and SPNs may reflect the clinicians’ level of experience in making these decisions. As telephone reviews become more regular, it is important to appreciate the evolving challenges that rheumatology clinicians may face in the post-pandemic years and any issues are identified and addressed accordingly.
Disclosure
A. Ramli: None. X. Ong: None. S. Chitale: None. E. Gladston Chelliah: None.