Establishing a Graft-Versus-Host Disease (GVHD)-Focused Multidisciplinary Telehealth Clinic

• Published in: Transplantation and cellular therapy 2024-12, Vol.30 (12), p.1215.e1-1215.e11
• Main Authors: Harris, Andrew C., Markova, Alina, Devlin, Sean, Singh, Amandeep, Susman, Pamela, Brown, Soni, Grasso, Christine, Custodio, Christian, Estilo, Cherry, Ibanez, Katarzyna, Myers, Michelle, Syrkin, Grigory, Yom, SaeHee, Perales, Miguel-Angel, Ponce, Doris M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Child; Child, Preschool; Female; Graft vs Host Disease; GVHD; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Male; Middle Aged; Patient Care Team; Quality of Life; Telehealth; Telemedicine; Young Adult
• ISSN: 2666-6367; 2666-6367
• DOI: 10.1016/j.jtct.2024.09.016

•A telehealth platform with multidisciplinary approach was developed for GVHD care.•Female patients had increased visits via telehealth, reducing gender inequalities.•Increased proportion of patients from far distances were seen via telehealth.•Patients reported significant reduction in distress after attending GVHD clinic.•Our findings support the ongoing development of a virtual platform to improve access to specialized GVHD care. Graft-versus-host disease (GVHD) is a complication following allogeneic hematopoietic cell transplant that frequently causes multiorgan affection and decrease in quality of life. Global assessment and care of these patients require a multidisciplinary approach, but access to focused clinics is limited given their scarcity and location in major cities, as well as mobility and transportation challenges that frequently affect these patients. Thus, we established a multispecialty GVHD telehealth (TH) clinic and hypothesized that a virtual platform will expand access to clinical care in children and adults. The clinic team members included BMT specialist, nursing, dermatologist, dentist, nutritionist, physiatrist, research personnel, and others as needed. We evaluated all GVHD-related visits (in-person and TH) conducted in a single center from 01/2022 to 12/2022. Ninety-three patients received a total of 308 visits, and one-third were via TH. Approximately half of the in-person group had at least 1 TH visit, and 10 patients were seen exclusively via TH. Most patients had advanced chronic GVHD. More male patients were seen in GVHD clinic, but female patients had increased in clinic visits via TH (41% TH versus 32% in-person). One-third of clinic visits were from patients of racial and ethnic minorities. While only 6% (n = 12/217) of in-person visits were for patients living >100 miles from the center, 34% (n = 31/91) of TH visits were from far distances including out-of-state. At baseline, the most common patient-reported symptoms in a subset of patients included fatigue, disturbed sleep, and distress. Fifteen patients completed a follow-up symptom survey and reported significantly reduced distress regarding their GVHD (P = .02), although other symptoms remained stable. A multidisciplinary TH clinic provided care for adult and pediatric patients with GVHD. We demonstrated preliminary feasibility of building a robust TH platform with a collaborative multispecialty approach that allowed access and continuity of medical care. Gender ine