{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T09:01:41Z","timestamp":1793091701029,"version":"4.5.0"},"reference-count":19,"publisher":"Oxford University Press (OUP)","issue":"7-8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To compare patterns of rheumatology consultations and outcomes across four different platforms in the Military Health System (MHS): face-to-face, synchronous telehealth, and two asynchronous telehealth platforms.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We conducted a retrospective review comparing face-to-face rheumatology consults during 2019 with teleconsultations from three virtual systems in the MHS: an asynchronous email-based system from May 2006 to Feb 2018, a web-based platform from 2014 to 2018, and synchronous telehealth consults from March 2020 to March 2021. Consults were reviewed for diagnosis, and if medical evacuation was required for consults originating OCONUS or if face-to-face follow-up was required for synchronous teleconsults. Diagnoses of interest included inflammatory arthritis, noninflammatory arthritis, crystalline arthritis, myositis, lupus, vasculitis, fibromyalgia, antibody positivity without diagnosis, symptoms without specified diagnosis, and a composite of other rheumatic diseases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Leading diagnoses across platforms were inflammatory arthritis, noninflammatory arthritis, and a composite of other diagnoses. Consultation modality influenced the type of cases seen. Inflammatory arthritis accounted for significantly more consults in the synchronous telehealth (38.4%) and email-based (40.9%) models than in the web-based (23.7%) and face-to-face (32.0%) models. The composite of other diagnoses was the leading diagnosis for the asynchronous web-based model (32.9%), which was significantly more than the synchronous telehealth and face-to-face consults. Synchronous models saw significantly more cases of crystalline arthritis, vasculitis, and fibromyalgia.<\/jats:p>\n                  <jats:p>Email-based consultations resulted in medical evacuation in 25 cases and prevented evacuation in 5. Web-based consultations prompted medical evacuation in 100 cases. In the synchronous model, face-to-face follow-up was recommended in 142 (15%) cases.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Modality of consultation influences the type of cases seen. Both synchronous and asynchronous telerheumatology models were able to answer the consult question without referral for face-to-face evaluation in 79.9-85.0% of consults, suggesting teleconsultation is a viable method to increase access to high-quality rheumatology care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab531","type":"journal-article","created":{"date-parts":[[2021,12,28]],"date-time":"2021-12-28T10:14:58Z","timestamp":1640686498000},"page":"e1456-e1461","source":"Crossref","is-referenced-by-count":1,"title":["Comparing Rheumatology Consultation Patterns Across Telehealth Platforms and Face-to-Face Clinic in the Military Health System"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7999-5415","authenticated-orcid":false,"given":"Michael F","family":"Loncharich","sequence":"first","affiliation":[{"name":"Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David F","family":"Desena","sequence":"additional","affiliation":[{"name":"Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelique N","family":"Collamer","sequence":"additional","affiliation":[{"name":"Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jess D","family":"Edison","sequence":"additional","affiliation":[{"name":"Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"},{"name":"Rheumatology Service, Department of Medicine, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,12,28]]},"reference":[{"key":"2023072301084520100_R1","article-title":"Examining associations between relocation, continuity of care, and patient satisfaction in military spouses","volume":"183","author":"Gleason","year":"2017","journal-title":"Mil Med"},{"key":"2023072301084520100_R2","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.7205\/MILMED-D-12-00076","article-title":"A model for patient-centered army primary care","volume":"177","author":"Lewis","year":"2012","journal-title":"Mil Med"},{"key":"2023072301084520100_R3","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1056\/NEJMsa0804116","article-title":"Patient\u2019s perception of hospital care in the United States","volume":"369","author":"Jha","year":"2008","journal-title":"N Engl J Med"},{"key":"2023072301084520100_R4","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1002\/acr.23518","article-title":"2015 American College of Rheumatology workforce study: supply and demand projections of adult rheumatology workforce, 2015-2030","volume":"70","author":"Battafarano","year":"2018","journal-title":"Arthritis Care Res"},{"key":"2023072301084520100_R5","article-title":"Army rheumatology consultant\u2019s update","author":"Mount"},{"key":"2023072301084520100_R6","article-title":"Air Force rheumatology consultant\u2019s update","author":"Scott"},{"key":"2023072301084520100_R7","first-page":"e306","article-title":"Televascular consultation is the answer to rural vascular surgery shortage","volume":"72","author":"Reed","year":"2020","journal-title":"J Vasc Surg"},{"key":"2023072301084520100_R8","doi-asserted-by":"crossref","DOI":"10.1186\/s12960-020-0448-3","article-title":"Physician workforce in the United States of America: forecasting nationwide shortages","volume":"18","author":"Zhang","year":"2020","journal-title":"Hum Resour Health"},{"key":"2023072301084520100_R9","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1097\/RHU.0b013e3182a6a490","article-title":"Assessing the need for improved access to rheumatology care: a survey of Massachusetts community health center medical directors","volume":"19","author":"Feldman","year":"2013","journal-title":"J Clin Rheumatol"},{"key":"2023072301084520100_R10","doi-asserted-by":"crossref","first-page":"3017","DOI":"10.1002\/art.38167","article-title":"Regional distribution of adult rheumatologists","volume":"65","author":"American College of Rheumatology Committee on Rheumatology Training Workforce Issues","year":"2013","journal-title":"Arthritis Rheum"},{"key":"2023072301084520100_R11","article-title":"Telemedicine [Position Statement]","author":"American College of Rheumatology"},{"key":"2023072301084520100_R12","article-title":"Tiered telehealth health care support for COVID-19. 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