A Focused Multidisciplinary Telehealth Clinic Increased Patient Access and Significantly Reduced Distress in Patients with Gvhd.

Background GVHD is a complex-immune mediated complication that frequently affects multiple organs and decreases the quality of life after allo-HCT. Global assessment and care of these pts require a multispecialty approach. However, access to focused clinics providing such care is limited given their scarcity and location in major cities, as well as mobility and transportation challenges that frequently affect these pts. Thus, we established a multispecialty GVHD telehealth (TH) clinic to expand access to specialized care. We hypothesized that a TH platform will expand access to clinical care in children and adults. Methods A virtual platform was implemented, and a GVHD informational packet with a photo guide, nutritional, dental care and stretching exercises guidelines were provided to each pt. The clinic team members included BMT specialist, dermatology, dental, nutrition, physiatrist, research personnel and others as needed. A patient-reported outcomes (PROM) questionnaire was adapted electronically. We evaluated all GVHD-related visits (in-person and telemedicine) conducted in a single center from 01/22 to 12/22. Results A total of 308 visits were performed, and 1/3 (n=91) were conducted via TH. The median number of clinic visits per pt was 3 (range 1-11) whereas telehealth was 1 (1-9). Approximately half of the in-person group had at least 1 TH visit, and 10 pts were seen exclusively via TH. The whole group had a median age of 50 and more pts were male (66%). The TH group had a median age of 56 and 59% were male (Table). Most of the pts had advanced cGVHD. Approximately 1/3 of pts were from racial and ethnic minorities. While only 6% (n=12/217) of in-person visits were from pts living >100 miles from the center (Fig. 1A), 33% (n=29/91) of TH visits were from far distances including out-of-state (Fig. 1B). At baseline, the most common patient-reported symptoms in a subset of pts included fatigue, difficulty sleeping, distress, and decreased general activity (Fig. 2A). At a follow-up survey, most symptoms remained stable except for distress which was significantly reduced (p =0.02, Fig. 2B). Conclusions A multidisciplinary TH clinic provided care for adult and pediatric pts with GVHD, most with advanced disease. We demonstrated the feasibility of building a robust TH platform with a collaborative multispecialty approach that allowed continuity of care by either complementing in-person visits or serving as the sole source of GVHD care. Distance to our center represented a lesser barrier to attending specialized care via TH, and patients reported a significant reduction in distress. While our findings support the ongoing development of a virtual platform to improve access to specialized GVHD care, the increasing medical licensing restrictions across state lines post-COVID pandemic may hamper our collective efforts.