Paediatric rheumatology fails to meet current benchmarks


By Siobhan Calafiore

22 Mar 2024

Bolstering the paediatric rheumatology workforce and taking advantage of technology will help address the current shortcomings in the clinical management of children with juvenile idiopathic arthritis, researchers say.

In a review for Current Rheumatology Reports [link here], they said globally, paediatric rheumatology services were still failing to meet the benchmarks of best practice despite legislative changes to increase ‘unlucrative’ paediatric research in the early 2000s and major molecular medicine advancements.

A major part of the problem was that demand on paediatric rheumatology services far exceeded supply due to chronic workforce shortages, said the researchers, led by University of Newcastle.

They pointed to a workforce report showing a 67% deficit based on minimum standards, with 20 paediatric rheumatology working in Australia in 2021 – well below the recommended 61 to meet the current workload.

Further, the workforce shortage was exacerbated in regional and rural areas and only expected to worsen, placing children at risk of delayed and inadequate treatment as well as poor disease outcomes, they continued.

They blamed the lack of paediatric education on musculoskeletal and rheumatic diseases at medical schools and a “slow recognition” of paediatric rheumatology as a subspecialty for the minimal interest from junior doctors.

This knowledge gap carried across other disciplines such as general practice, resulting in delayed referrals and diagnosis, and diagnostic errors.

“Action must be taken now, to train and well-equip the paediatric rheumatology interdisciplinary workforce,” the researchers wrote.

“We propose, a resource-efficient way to improve the quality of care provided could be achieved by embedding digital health into clinical practice, to create an integrative care model between the children, general practice and the paediatric rheumatology team.”

They said improvements were also needed in virtual examination delivery following the rapid rise in telehealth consultations as a result of the pandemic, including the validation or adaption of current assessment tools.

Mobile digital devices such as smartphones, tablets and smart watches could also be used for reliable monitoring and assessment in real-time, providing health indicators that could support successful management.

They could also aid in medical adherence and physical activity checks.

“Notably, this model of digital health care also asserts the principles of person-centred care, because it requires engagement from children, and has the potential to improve communication between the child, parent and their wider healthcare team,” the researchers said.

“Therefore, it is crucial that future research and advancements in 5G digital health interventions should directly focus on addressing the long-standing health inequalities experienced by children with juvenile idiopathic arthritis, particularly for those living in remote or regional areas; in fact, any area or country far from paediatric rheumatologists and specialised centres.”

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