Changes in Service Delivery and Access to Rheumatologists Before and During the COVID-19 Pandemic in a Canadian Universal Healthcare Setting

Kwok, Timothy S H; Kuriya, Bindee; King, Lauren; Eder, Lihi; Thorne, John; Li, Zhiyin; Stukel, Thérèse A.; Fu, Longdi; Kopp, Alexander; Widdifield, Jessica

doi:10.3899/jrheum.220658

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…In our study, patients initiating apremilast via telehealth were more likely to have seen a rheumatologist. This is consistent with a study that reported a sharp increase in telehealth use by rheumatologists [ 38 ], and a systematic review showed telehealth visits led to similar disease activity control and patient-reported outcomes as in-person care [ 51 ]. Finally, we found patients initiating apremilast via telehealth were more likely to have had a telehealth visit during baseline.…”

Section: Discussionsupporting

confidence: 91%

“…Telehealth services have expanded over the last 5 years, but the increase in these services significantly increased during the COVID-19 pandemic as in-person medical services for multiple diseases were postponed or cancelled [ 36 , 37 ]. In addition, patients receiving healthcare via telehealth services maintained or increased medication adherence and increased medication fills compared to those with in-person visits [ 28 , 38 – 44 ]. Our study findings corroborate those from previous studies using telehealth on patients with PsO and PsA [ 45 – 48 ].…”

Section: Discussionmentioning

confidence: 99%

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Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic

Das

Chang

Paydar

et al. 2023

Dermatol Ther (Heidelb)

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Introduction Limited access to healthcare during the COVID-19 pandemic prompted patients to seek care using telehealth. In this study, we assessed whether treatment patterns differed for patients with psoriasis (PsO) or psoriatic arthritis (PsA) initiating apremilast by either a telehealth or an in-person visit. Methods We estimated adherence and persistence among US patients in the Merative© MarketScan© Commercial and Supplemental Medicare Databases who newly initiated apremilast between April and June 2020, categorized by the type of visit (telehealth or in-person) when apremilast was first prescribed. Adherence was defined as the proportion of days covered (PDC), with PDC ≥ 0.80 considered to indicate high adherence. Persistence was defined as having apremilast available to take without a 60-day gap during follow-up. Factors associated with high adherence and persistence were estimated with logistic and Cox regression. Results Among apremilast initiators ( n = 505), the mean age was 47.6 years, 57.8% were female, and the majority had PsO (79.6%). Telehealth index visits were more likely among patients residing in Northeast USA (odds ratio [OR] 3.31, 95% confidence interval [CI] 1.63–6.71) and Western USA (OR 2.52, 95% CI 1.07–5.93]), those with a prescribing rheumatologist (OR 2.27, 95% CI 1.10–4.68), and those with any baseline telehealth visit (OR 1.91, 85% CI 1.20–3.04). Those initiating apremilast with a telehealth visit ( n = 141) had similar mean PDC to those initiating apremilast with an in-person visit ( n = 364) (0.695 vs. 0.728; p = 0.272). At the end of the 6-month follow-up, 54.3% of the overall population had high adherence (PDC ≥ 0.80) and 65.1% were persistent. After adjusting for potential confounders, patients initiating apremilast via telehealth had similar full adherence (OR 0.80, 95% CI 0.52–1.21) and persistence as those initiating apremilast in-person. Conclusion Patients with PsO and patients with PsA initiating apremilast via telehealth or in-person during the COVID-19 pandemic had similar medication adherence and persistence during the 6-month follow-up period. These data suggest that patients initiating apremilast can be as effectively managed with telehealth visits as with in-person visits. Supplementary Information The online version contains supplementary material available at 10.1007/s13555-023-00967-3.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic

Das

Chang

Paydar

et al. 2023

Dermatol Ther (Heidelb)

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“…This risk period after exposure is based on the concept that if individuals with RA experience a flare after a vaccine, delays in seeing their rheumatologist may be because of potential access issues heightened during the pandemic. 17 Analysis. Events were ascertained across control and risk periods.…”

Section: Study Populationmentioning

confidence: 99%

Safety and Healthcare Use Following COVID-19 Vaccination Among Adults With Rheumatoid Arthritis: A Population-Based Self-Controlled Case Series Analysis

Lee,

Bernatsky,

Kwong

et al. 2023

J Rheumatol

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ObjectiveTo determine if COVID-19 vaccines were associated with adverse events of special interest (AESIs) and health care use among adults with rheumatoid arthritis (RA).MethodsAmong adults with RA who received at least 1 COVID-19 vaccine, a self-controlled case series (SCCS) analysis was conducted to evaluate relative incidence (RI) rates of AESIs (Bell's Palsy, Idiopathic Thrombocytopenia, Acute Disseminated Encephalomyelitis, Pericarditis/Myocarditis, Guillain-Barre syndrome, Transverse Myelitis, Myocardial Infarction, Anaphylaxis, Stroke, Deep Vein Thrombosis, Pulmonary Embolism, Narcolepsy, Appendicitis, and Disseminated Intravascular Coagulation) in any 21-day period following vaccination compared to control periods. Secondary outcomes included emergency department (ED) visits, hospitalizations, and rheumatology visits. A matched non-RA comparator group was created and a separate SCCS analysis was conducted. Relative incidence ratios (RIR) were used to compare between RA and non-RA groups.ResultsAmong 123,466 RA patients and 493,864 comparators, the majority received mRNA vaccines. For RA patients, relative to control periods, AESIs were not increased. ED visits increased after dose 2 [RI:1.06 (95%CI:1.03-1.10)] and decreased after dose 3 [RI:0.93 (95%CI:0.89-0.96)]. Hospitalizations were lower after the first [RI:0.83 (95%CI:0.78-0.88)], second [RI:0.86 (95%CI:0.81-0.92)], and third [RI:0.89 (95%CI:0.83-0.95)] doses. Rheumatology visits increased after dose 1 [RI:1.08 (95%CI:1.07-1.10)], and decreased after doses 2 and 3. Relative to comparators, RA patients had a higher AESI risk after dose 3 [RIR:1.28 (95%CI:1.1- 1.6)]. RA patients experienced fewer ED visits [RIR:0.73 (95%CI:0.58-0.90)] and hospitalizations [RIR:0.52 (95%CI:0.36-0.75)] after dose 4.ConclusionCOVID-19 vaccines in RA patients was not associated with an increase in AESI risk or health care utilization after every dose.

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“…Hospital patient volumes decreased during the beginning stages of the pandemic in multiple medical disciplines, including radiology, emergency, and surgery departments [1][2][3][4]. Decreases in volumes were also seen in individual practices, such as those in dermatology and rheumatology [5,6]. The effects on patient volumes during the COVID-19 pandemic were also seen internationally, with hospitals around the world noting a decrease in hospital revenue [7,8].…”

Section: Introductionmentioning

confidence: 99%

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations

Patel

Rashid

Spear

et al. 2023

Life

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The Coronavirus Disease 2019 (COVID-19) pandemic ushered in rapid changes in healthcare, including radiology, globally. This review discusses the impact of the pandemic on various radiology departments globally. We analyze the implications of the COVID-19 pandemic on the imaging volumes, finances, and clinical operations of radiology departments in 2020. Studies from health systems and outpatient imaging centers were analyzed, and the activity throughout 2020 was compared to the pre-pandemic activity, including activity during similar timeframes in 2019. Imaging volumes across modalities, including MRI and CT scans, were compared, as were the Relative Value Units (RVUs) for imaging finances. Furthermore, we compared clinical operations, including staffing and sanitation procedures. We found that imaging volumes in private practices and academic centers decreased globally. The decreases in volume could be attributed to delayed patient screenings, as well as the implementation of protocols, such as the deep cleaning of equipment between patients. Revenues from imaging also decreased globally, with many institutions noting a substantial decline in RVUs and revenue compared with pre-COVID-19 levels. Our analysis thus found significant changes in the volumes, finances, and operations of radiology departments due to the COVID-19 pandemic.

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Changes in Service Delivery and Access to Rheumatologists Before and During the COVID-19 Pandemic in a Canadian Universal Healthcare Setting

Cited by 5 publications

References 21 publications

Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic

Apremilast Adherence and Persistence in Patients with Psoriasis and Psoriatic Arthritis in the Telehealth Setting Versus the In-person Setting During the COVID-19 Pandemic

Safety and Healthcare Use Following COVID-19 Vaccination Among Adults With Rheumatoid Arthritis: A Population-Based Self-Controlled Case Series Analysis

A Global Review of the Impacts of the Coronavirus (COVID-19) Pandemic on Radiology Practice, Finances, and Operations

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