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

Abstract

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.

Work situation of rheumatologists and residents in times of COVID-19

“…The findings reveal that every sixth rheumatologist has suffered from stress at least once in the past and the poor ratings of support services are a wakeup call. High levels of stress and mental health risks were also reported by other studies, although the results from different countries and surveys (which have applied different research aims and use different methods) may not be fully comparable [ 25 , 28 , 38 ]. Our material revealed that COVID-19 was an amplifier of stress.…”

“…According to another US report, 32% of the surveyed rheumatologists felt burned out, of whom 29% stated that it began after the COVID-19 pandemic [ 25 ]. A survey in the United Kingdom revealed that “[t]wo-third of responders felt anxious about the ill-effects of COVID-19 on their health and wellbeing, and one third of them were redeployed” [ 28 ]. These findings are highly alarming, but evidence for German rheumatologists is still lacking.…”

Clinical decision-making in remote rheumatology consultations: a service evaluation of new patient and inflammatory rheumatic disease follow-up appointments

“…Consequently, clinicians may feel reluctant to make diagnoses/escalate immunosuppression without seeing patients in person, leading to many remote consultations converting to face-to-face reviews. This is particularly true for newly referred patients, with many rheumatology clinicians avoiding the use of remote appointments for new patients [ 3 ].…”

The COVID-19 Pandemic and Rheumatology: Impact on Providing Care in Latin America and Around the World

“…10 Besides shielding measures and national lockdowns, redeployment of rheumatology providers as reported by different studies certainly played a role in these changes. 11 Outside of clinical care, rheumatologists have also played an active role in research even beyond that involving the treatment of patients with rheumatic disease; they have had important roles in the treatment of several complications of COVID-19. 12,13,14 The adoption of telemedicine in rheumatology has been quite heterogeneous, and similar to the results reported by Fernández-Ávila and colleagues, 5 some rheumatologists still have some hesitation about its use even past the pandemic.…”

“…In a survey distributed among UK rheumatology healthcare professionals including 172 participants (49% consultants, 25% nurse specialists, and 12% specialty trainees), 90% used this modality in less than 1 in 4 consultations, despite the availability of video consultation for the majority of participants. 11 The limitations of providing care through telehealth, especially to new patients, are not trivial, but there is also much that can be accomplished in this model of care. Many would agree that for a known patient, the telehealth appointment can provide almost everything except the physical aspects of the patient-doctor interaction.…”