Impact of COVID-19 pandemic on the management of patients with RA: a survey of rheumatologists in six European countries

Abstract

Objectives We aimed to describe, from the perspective of rheumatologists in Europe, how the COVID-19 pandemic has impacted their management of people with rheumatoid arthritis (RA) and the continuing medical education of physicians. Methods Rheumatologists participating in the Adelphi RA Disease Specific Programme™ in six European countries were contacted in August and September 2020 for a telephone survey. Rheumatologists were asked seven attitudinal questions on changes to patient management, prescription behaviour, and continuing education due to COVID-19. Results were summarised with descriptive statistics. Results The telephone survey was completed by 284 rheumatologists. The most commonly reported changes to patient management were increased utilisation of video/telephone consultations (66.5% of respondents), fewer visits (58.5%), and limiting physical contact (58.1%). Furthermore, 67.9% of rheumatologists who indicated prescribing behaviour had changed switched their patients to self-administered medication and 60.7% reported not starting patients on targeted synthetic disease-modifying antirheumatic drugs (DMARDs), biologic originator DMARDs, or biosimilar DMARDs. In total, 57.6% of rheumatologists believed changes in management would persist. Rheumatologists reported that 38.0% of patients expressed concerns about how COVID-19 would impact treatment, including access to treatment and the risk of infection. The biggest impact on rheumatologist education was a switch to online training and conferences. Conclusions All countries saw changes in patient management and prescribing behaviour, including the rapid uptake of telemedicine. It is important that the international rheumatology community learns from these experiences to better prepare for future pandemics and to address ongoing rheumatologist shortages. Lay Summary What does this mean for patients ? We asked rheumatologists a series of questions to find out how COVID-19 affected the way they interact with their patients with rheumatoid arthritis. We found that rheumatologists switched to online or telephone appointments in most countries to obey social distancing rules. Rheumatologists also reduced prescription of advanced medicines, most likely as a response to patient fears that such therapies may increase infection risk. There were differences between countries in changes made to patient treatment likely caused by differences in COVID-19 case numbers and where patients saw their doctor. We also found that doctor education moved mostly online. These results will help guide doctors in case of future pandemics as well as helping to plan future studies into how online appointments may be best used, who they are suitable for, and how they may be used to ensure patients can see a rheumatologist when they need to. They also highlight a need for continued monitoring of patients to ensure medication changes do not reduce effectiveness of treatment in the long-term.

The Use of Remote Consultations and Associated Factors in Rheumatology: A Large Retrospective Cohort Study of Follow‐Up Consultations Before, During, and After COVID‐19

“…The proportion of consultations being performed remotely sharply increased from less than 15% (of all consultations) before March 2020 to more than three‐quarters in April 2020. This rapid increase is in line with the national and local COVID‐19 policies and seen in other studies 19–21 . The proportion of RCs then declined rapidly to about one‐third after COVID‐19, which was also observed previously 22 .…”

“…This rapid increase is in line with the national and local COVID-19 policies and seen in other studies. [19][20][21] The proportion of RCs then declined rapidly to about one-third after COVID-19, which was also observed previously. 22 This might be explained due to the increased need for physical examinations and the need for F2F visits to maintain the patient-HCP relationship as the pandemic continued.…”

“…We did not find associations between HCP factors and the use of RCs. Other factors might play a more important role for HCPs, such as hospital policy or factors that were not assessed in this study 21 …”

Global Perspective on the Impact of the COVID‐19 Pandemic on Rheumatology and Health Equity

“…This is a missed opportunity for the best patient care (47). Variations were observed among countries due to the impact of the pandemic, response strategies, and telemedicine regulations (48).…”

“…Omicron has become the most prominent variant, leading to less severe infections, and resulting in a decrease in COVID‐19 public concern. However, the long‐term sequelae of COVID‐19, commonly referred to as Long COVID, continue to affect millions of people in Europe and worldwide (48). It remains unclear whether Long COVID is more frequent in individuals with rheumatic diseases, and further studies are warranted.…”