Disruptions in Rheumatology Care and the Rise of Telehealth in Response to the COVID‐19 Pandemic in a Community Practice–Based Network

Abstract

Background The effect of the COVID19 pandemic on community‐based rheumatology care and use of telehealth is unclear. Methods Using a community practice‐based rheumatologist network, we examined trends in in‐person vs. telehealth visits vs. canceled visits in three time periods: pre‐COVID19, COVID19‐Transition (6‐weeks beginning 3/23/20), and post‐COVID19‐Transition (May‐August). In the Transition period, we compared patients who received in‐person care vs. telehealth visits vs. cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits. Results Pre‐COVID19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by approximately 300 providers practicing in 92 offices. This decreased substantially (24.6% reduction) during COVID19‐Transition period for in‐person but rebounded to pre‐COVID19 levels during post‐COVID19 transition. There were almost no telehealth visits pre‐COVID19, but telehealth increased substantially during the COVID19‐Transition (41.4% of all follow‐up visits) and slightly decreased during post‐COVID19‐Transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with greater likelihood of cancelling visits. Most factors were also associated with a lower likelihood of having telehealth vs. in‐office visits. Patients living further from the rheumatologists’ office were more likely to use telehealth. Conclusion COVID19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID‐19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.

Healthcare disparities in telemedicine for rheumatology care

“…Throughout the COVID-19 era, telemedicine has been an important part of rheumatology practice but disparities in access to care have persisted for certain vulnerable groups [7 ▪ ,20,36]. Furthermore, lower telemedicine use in vulnerable populations have threatened to intensify prevailing disparities in the care of people with rheumatic disease [7 ▪ ]. Telemedicine services have been disproportionately underutilized by racial/ethnic minorities, patients with lower socioeconomic status, and older patients [7 ▪ ,20,36,37].…”

“…Disparities in use of telemedicine have been observed in a few recent studies of people with rheumatic disease. A large, multistate, community rheumatology practice found that older age, lower socioeconomic status, and rural residence were associated with lower use of telemedicine [7 ▪ ]. Additionally, cancellations for outpatient follow-up visits occurred more often in people who were older, of black race or Hispanic, of lower socioeconomic status, and living in rural areas [7 ▪ ].…”

“…telemedicine) [6]. Telemedicine was rapidly adopted as a potential solution to provide care to rheumatology patients in the setting of the coronavirus disease 2019 (COVID-19) pandemic [7 ▪ ,8,9 ▪▪ ], and several models have been suggested to address access, health equity, and quality of care barriers [10,11]. Within rheumatology, telemedicine provides an opportunity to address several barriers to adequate care including workforce shortages [12], reaching patients in rural or medically underserved areas [13] or those reluctant to present for in-person care because of the risks of contracting COVID-19 [14].…”

Medication Interruptions and Subsequent Disease Flares During the COVID‐19 Pandemic: A Longitudinal Online Study of Patients With Rheumatic Disease

“…Prior studies have shown that patients with ARDs had frequent health care disruptions and interruptions in the use of their disease-modifying antirheumatic drugs (DMARDs) early in the COVID-19 pandemic (11,12). Little is known, however, about how these disruptions affected patient health or how patient concerns and behaviors changed over time.…”

Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study

“…During the course of these public health restrictions, we have shown that individuals with MSK conditions experienced difficulties accessing both community and specialist healthcare services. Most studies to date exploring access to healthcare have focused on access to rheumatology specialist services [ 19 , 34 , 35 , 37 , 38 ]. In keeping with other studies, we found that the COVID-19 pandemic led to reduced access to specialist care for people with MSK conditions [ 19 , 35 , 39 ].…”