Social Distancing, Health Care Disruptions, Telemedicine Use, and Treatment Interruption During the COVID‐19 Pandemic in Patients With or Without Autoimmune Rheumatic Disease

Abstract

Background We aimed to compare concerns, social distancing, health care disruptions, and telemedicine use in patients with autoimmune rheumatic disease (ARD) and non‐ARD and to evaluate factors associated with immunomodulatory medication interruptions. Methods Patients in a multistate community rheumatology practice network completed surveys from April 2020 to May 2020. Adults with common ARD (rheumatoid arthritis, spondyloarthritis, systemic lupus erythematosus) or non‐ARD (gout, osteoarthritis, osteoporosis) were evaluated. Concerns about coronavirus disease 2019 (COVID‐19), social distancing, health care disruptions, and telemedicine use were compared in patients with ARD versus non‐ARD, adjusting for demographics, rural residence, and zipcode‐based measures of socioeconomic status and COVID‐19 activity. Factors associated with medication interruptions were assessed in patients with ARD. Results Surveys were completed by 2319/36 193 (6.4%) patients with non‐ARD and 6885/64 303 (10.7%) with ARD. Concerns about COVID‐19 and social distancing behaviors were similar in both groups, although patients receiving a biologic or Janus kinase (JAK) inhibitor reported greater concerns and were more likely to avoid friends/family, stores, or leaving the house. Patients with ARD were less likely to avoid office visits (45.2% vs. 51.0%, odds ratio [OR] 0.79 [0.70‐0.89]) with similar telemedicine use. Immunomodulatory medications were stopped in 9.7% of patients with ARD, usually (86.9%) without a physician recommendation. Compared with patients with an office visit, the likelihood of stopping medication was higher for patients with a telemedicine visit (OR 1.54 [1.19‐1.99]) but highest for patients with no visits (OR 2.26 [1.79‐2.86]). Conclusion Patients with ARD and non‐ARD reported similar concerns about COVID‐19 and similar social distancing behaviors. Missed office visits were strongly associated with interruptions in immunomodulatory medication.

Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: from infection severity to impact on care provision

“…Reductions in DMARD use have been reported in other studies 17 19–22. Our results regarding 2020 suggest marked changes compared with 2019 (decreasing starts and increasing stops of bDMARDs/tsDMARDs); such changes in dispensations could be affected by treatment hoarding or prioritisation of use for COVID-19.…”

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

“…We previously found that patients who avoided office visits early in the pandemic were the most likely group to stop a DMARD, but that patients who replaced these missed visits with telemedicine were less likely to stop a DMARD (11,16). In the current study, avoiding office visits at baseline was associated with increased future interruptions in DMARD use, but there was no association between telemedicine and interruptions in DMARD use.…”

Healthcare disparities in telemedicine for rheumatology care

“…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].…”