From smart working to smart Co-working in the COVID-19 era: a pilot program of cooperation on chronic endocrinological and rheumatological disease

Abstract Background: The last months were signed by the pandemic diffusion of COVID-19, with the need to minimize the inflow of children and adolescents affected by chronic diseases into the hospitals. Otherwise, paediatricians had to limit visits and to consider a new setting for febrile children.Patients were assisted by telephonic consultations guaranteed by the paediatricians of free choice and by the paediatric specialists. However, patients frequently needed a direct specialistic evaluation in the case of flares, abnormal laboratory parameters and adverse reactions to drugs.Another frequent question was the differential diagnosis of febrile episodes, to distinguish a recurrent fever, linked to autoinflammation, from an infectious disease.We proposed to paediatricians of free choice in west-Sicily a questionnaire about difficulties met in the follow-up of children with rheumatologic diseases, autoinflammatory syndromes, congenital hypothyroidism. Results: 55 questionnaires were collected: the most frequent recorded conditions were periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA syndrome) and Familial Mediterranean Fever; Juvenile Idiopathic Arthritis, congenital hypothyroidism.All the paediatricians needed specialistic support to adequately control flares, adjustment of drugs dosage. Conclusions: Patients and paediatricians need a specialistic support for the follow-up and to reach a good compliance to treatment.This period characterized by smart working, telemedicine, strategies to monitor remotely the patients, can find the winning strategy in the approach of the “Co-working”, a new cooperation between hospital and paediatricians of free choice, in the global follow-up of paediatric chronic diseases.