title: Out-of-clinic patient communication in paediatric rheumatology: the extent and nature of demand.
abstract: BACKGROUND
  Traditional funding models for public paediatric rheumatology care are typically based on providing medical services for a defined number of clinics per week. Anecdotally there is significant demand by patients and families for out-of-clinic communication with care providers and services provided under traditional funding models may not meet this need. Our aim was to determine the extent and nature of this 'hidden' demand in a tertiary paediatric rheumatology centre.
  
  
  METHODS
  Communication data and diagnoses were extracted from the Rheumatology service database at our centre for the period 1/1/2009 to 31/12/2011. Clinical activity data over the same time were obtained from hospital clinic databases.
  
  
  RESULTS
  There were 5672 instances of communication with 749 patients/families over 3 years, (mean 7.3/weekday). This increased over time in parallel with clinical activity. 41% of clinic patients sought communication with the team out of clinic hours. 58% were telephone calls, 36% emails and 6% letters. The communication topics were for advice, results or general updates (28%), medication queries (24%), appointment/admission coordination (20%), disease flare or other disease events (14%), psychosocial, school or transition issues (6%) and miscellaneous queries (8%). Of the most frequent communicators, those with juvenile idiopathic arthritis were the majority (85%). The remainder had other chronic inflammatory conditions.
  
  
  CONCLUSIONS
  The communication and support needs of patients with chronic rheumatic diseases and their families extend beyond that which can be provided in the clinic environment. It is essential that funding for paediatric rheumatology services allows for staffing sufficient to meet this need.
authors.affiliation: Rheumatology Service, Department of General Medicine, The Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia. debi.feldman@rch.org.au.
authors.forename: Debi V
authors.initials: DV
authors.lastname: Feldman
authors.forename: Jo
authors.initials: J
authors.lastname: Buckle
authors.forename: Jane E
authors.initials: JE
authors.lastname: Munro
authors.forename: Roger C
authors.initials: RC
authors.lastname: Allen
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Akikusa