Challenges in delivering rheumatology care during COVID-19 pandemic

Nune, Arvind; Iyengar, Karthikeyan P; Ahmed, Ashar E; Sapkota, Hem

doi:10.1007/s10067-020-05312-z

Cited by 31 publications

(33 citation statements)

References 12 publications

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“…The risk of infections was thought to be slightly raised when patients with chronic inflammatory arthritis are treated with biologic anti-rheumatic drugs, particularly in elderly patients with co-morbidities [ 17 ]. The rationale to continue biologic drugs is mainly based on expert opinion and their clinical experience with the notion that the continuation of immunosuppressive drugs would minimise the disease flares and subsequent hospital admissions during the pandemic [ 5 , 18 ]. Although we did not specifically ask whether clinicians continued other forms of biologics, over 60% of clinicians favoured switching IV to SC biologics which is in line with NICE recommendation [ 4 ]; therefore, we can assume that most clinicians continued SC or oral forms of biologics for their patients.…”

Section: Discussionmentioning

confidence: 99%

“…To deliver safe and effective care to patients, a balance must be achieved between protecting patients and staff from viral transmission whilst providing a continuity of care. Rheumatology services across the UK had to be reconfigured and reorganised to rise to these challenges [ 5 ]. This survey evaluates the impact of the pandemic on rheumatology service provision as perceived by rheumatologists in the UK and various strategies adopted to provide effective clinical care.…”

Section: Introductionmentioning

confidence: 99%

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Impact of COVID-19 on rheumatology practice in the UK—a pan-regional rheumatology survey

et al. 2021

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The COVID-19 pandemic has disrupted healthcare services and rheumatology staff were redeployed to the frontline. The purpose of this survey was to evaluate the impact of the COVID-19 pandemic on the provision of rheumatology services as viewed by rheumatologists in the UK. Survey monkey questionnaire weblink was sent to 804 clinicians including consultant rheumatologists, speciality trainees, nurse specialists, and allied health professionals in 4 regions of the UK to evaluate personal effects of COVID-19 and redeployment, impact on current out-patient clinic activity, immunosuppressive drug use, and future rheumatology care. Response rate was 21%. One-fifth of the responders reported that their rheumatology departments were functioning less than 50% capacity during the pandemic. Two-third of responders felt anxious about the ill-effects of COVID-19 on their health and well-being, and one-third of them were redeployed. During the peak of the pandemic, 75% of clinicians stopped intravenous biologics. Although access to video consultation was available for up to three-fourths of the clinicians, the majority (90%) used this modality in less than 1 in 4 consultations. This survey highlights rheumatologists' perception in the delivery of future care and anxiety they faced. As demonstrated by this survey, the National Institute for Health and Care Excellence (NICE) guidance did not influence clinician decision making in some aspects of patient care. Underutilization of tele-rheumatology in this survey should be considered whilst planning the restoration of rheumatology services in the post-COVID era.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 on rheumatology practice in the UK—a pan-regional rheumatology survey

et al. 2021

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“…In rheumatology, various reports have broadly documented the use of telemedicine, highlighting both its advantages and potential drawbacks [ 1 ]. The British Society for Rheumatology has issued guidance for patients on immunosuppressants during the present period, which includes the advice to remain at home as much as possible [ 13 ], and it has been reported that many rheumatology clinics in the UK have temporarily converted large proportions of outpatient activity to telephone clinics [ 14 , 15 ]. Notwithstanding the obvious advantages of telemedicine, which are amplified during the current pandemic, and the many reports of its use, in reality only very few studies have been published on the impact of telemedicine in care of patients in rheumatology clinics.…”

Section: Introductionmentioning

confidence: 99%

Use of telemedicine during the COVID-19 pandemic in patients with inflammatory arthritis: a retrospective study on feasibility and impact on patient-reported outcomes in a real-life setting

Chevallard¹,

Belloli²,

Ughi³

et al. 2021

Rheumatol Int

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Close follow-up is mandatory in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS). During the Coronavirus Disease 2019 (COVID-19) pandemic, rheumatological care was rapidly reorganized during the first peak from March 1, 2020 to May 31, 2020, and all patients with RA, PsA, and AS being treated with a subcutaneous biologic disease-modifying anti-rheumatic drug or oral targeted synthetic disease-modifying anti-rheumatic drug were followed remotely. A retrospective database analysis of these 431 patients before and after this period is presented herein. A rheumatologist directly contacted all patients by telephone. Patients could also enter data on patient-reported outcomes remotely using the digital platform iAR Plus. General health (GH) and visual analog scale (VAS) pain were the main outcomes along with FACIT and disease-specific questionnaires (RADAI, ROAD, PROCLARA for RA, and BASDAI, BASGI, BASFI for AS). In all, 449 visits were postponed (69.9% of all scheduled visits); telephone evaluation was deemed inadequate in 193 instances, and patients underwent a standard outpatient visit. Comparing patients on telemedicine to those who underwent hospital visits, we found no statistically significant differences in GH (35.3 vs 39.3; p = 0.24), VAS (33.3 vs 37.1; p = 0.29), or other specific outcome measures in patients with RA, PsA, or AS. These results show that telemedicine has undoubted benefits, and in light of the ongoing COVID-19 pandemic, it is likely that many patients with these diseases may prefer it. Supplementary Information The online version contains supplementary material available at 10.1007/s00296-021-04863-x.

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“…Covid-19-pandemien har endret måten personer med revmatisk sykdom følges opp (4) og har synliggjort behovet for digitale alternativer som gir effektiv og trygg pasientoppfølging (5). Videokonsultasjoner kan bidra til bedre helsetjenestetilbud og vaere et akseptabelt alternativ til fysisk oppmøte for de som bor i avsidesliggende strøk (6)(7)(8).…”

Section: Fortolkningunclassified