key: cord-252521-m7asfqva
authors: Shah, Monica; Naik, Haley B.; Alhusayen, Raed
title: Hidradenitis suppurativa: the importance of virtual outpatient care during COVID-19 pandemic
date: 2020-05-01
journal: J Am Acad Dermatol
DOI: 10.1016/j.jaad.2020.04.142
sha: 
doc_id: 252521
cord_uid: m7asfqva

nan

Division of Dermatology, Department of Medicine 12 1 In addition to preventing the spread of infection, the role of the dermatologist is also to provide 33 appropriate care to patients with skin disease to prevent complications, and to lower the burden on the consulted with ED physicians for HS symptoms (of which, 36% consulted with more than 10 ED 45 physicians), and 30% made 10 or more trips to the ED in the pre-diagnosis stage. 2 Therefore, we strongly 46 disagree with categorizing HS follow-up as "non-urgent/reschedule", as outlined by Price et al. 1 , as this 47 approach would likely contribute to increased ED visits. 

Studies have also demonstrated increased risk of antidepressant drug use (P < .0001) and 57 completed suicide (P = .0334) in the HS population after adjusting for confounding factors. 5 We caution 58 against interruption in care for HS patients due to the potential for increased severity and/or frequency of 59 suicidal behaviours, depression and anxiety, especially considering the additive stress and anxiety 60 resulting from the current socially-isolating quarantine climate. 2 61 62

In our complex medical dermatology practices, we have implemented a similar triage system to 64

Price et al. with 3 categories: 1. in-person, 2. virtual/phone, 3. cancel/reschedule. We find that the follow-65 up of both HS and autoimmune bullous diseases through virtual visits is quite effective in a large 66 proportion of patients, during which we utilize patient-reported outcomes such as pain scores, treatment 67 satisfaction scores, and patient global assessments. Virtual visits also allow us to counsel patients 68 regarding maintenance regimens for the prevention of disease flares, HS action plans informing steps to 69 take during HS exacerbations and when to contact a provider, and methods to improve overall mental 70 health, including maintaining a healthy diet, utilizing warm compresses and engaging in support groups 71 through the CSPA. 2 72

Operations During COVID-19 Pandemic

Health Care Utilization Patterns and Costs for Patients 80

Impact of SARS on healthcare utilization by disease categories: 83 implications for delivery of healthcare services. Health Policy

Increased Suicide Risk in Patients with 86