Clinical care options for rheuma patients in lockdown

4 minute read

Online patient resources featuring exercise physiologists, dieticians, physiotherapists and rheumatologists reinforce a whole person approach to care.

Rheumatology patients in lockdown or otherwise unable to attend clinics can now access purpose-designed interactive online webinars, videos and live online guided exercise classes.

These resources feature exercise physiologists, dieticians, physiotherapists and rheumatologists providing education and encouragement.

Over 200 of the online resources, created by BJC Health in Sydney, have been made available for free to support the whole community during a challenging time. Others, such as the live exercise classes, require a paid subscription.

“We are trying to cope with the current lockdown as best we can,” said rheumatologist Dr Irwin Lim, co-founder of BJC Health and editor of Rheumatology Republic.

Dr Lim said that their online offering “will never replace face-to-face support. It is, however, designed to improve knowledge for patients and to try and reinforce behaviours by repetitive interaction and engagement.”

BJC Health is driven by a whole person care philosophy for predominantly rheumatology and musculoskeletal patients. Their business model extensively integrates in-house allied health professionals.

Such whole person care within one clinic is an uncommon innovation in Australian rheumatology. Errol Lim, physiotherapist and co-founder of BJC Health, said that they’ve tried many innovations over the years, “some of which have not worked”. But it is, perhaps, BJC Health’s inventive approach that enabled them to sidestep some the limitations caused by lockdowns last year.

“Prior to Covid-19 we launched an eight-week program offering our rheumatoid disease patients unlimited access to allied health through a WhatsApp group,” said Mr Lim.

Although they were never going to make money, he said, it was a significant learning in how to engage patients online and what their needs were outside of face-to-face consultations. Backed by this new knowledge, BJC Health springboarded its online offerings when lockdown hit in 2020.

“Zoom allowed us to accelerate every idea we’ve had for years. We’ve now got about 1200 unique members and more for the live events,” Mr Lim said. “We’ve always known that patients need a lot of support. When restrictions started last year, we knew we just had to keep in touch.”

As the pandemic continues, incorporating online services beyond telehealth may become a common consideration for clinicians setting up a business. Social media has increasingly been used for health care communication and support with security guidelines developed in the United Kingdom by the NHSX, the new joint health unit for digital transformation. The World Health Organisation has also used WhatsApp for covid-19 communication.

But although BJC Health is providing a rare solution of both online and whole person health services, their business model also raises contention.

“It is most uncommon,” said Professor Steven Hall, adjunct professor of medicine at Monash University Cabrini Hospital Melbourne. He said that “traditionally, an extended care plan was cobbled together by the GP”, highlighting that there are “complexities” for businesses, like BJC Health, which financially benefit from referrals to allied health.

But Professor Hall also acknowledges that some other practices are pegged to the academic career of the rheumatologist or, as in his own role as medical director of Emeritus Research, to clinical trials which receive financial gain from pharmaceutical companies.

“There is both a conflict,” he said, “and at the same time a sense of value adding to the patient. The question is: to what extent are we compromised by this financial gain and how transparent are we about it?”

For Errol Lim at BJC Health it all comes down to outcomes.

“Name me one condition where people don’t feel better when they focus on diet, exercise, mental wellness practices and sleep,” he said.

“It’s really hard to address all those in a 15-minute consult. You need to work as a team and hopefully, with BJC Health Connect, you’ve got that team. We’re actually trying to help the whole community. We’re actually just trying to do better.”


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