Management of Rheumatic Diseases During the COVID‐19 Pandemic: A National Veterans Affairs Survey of Rheumatologists

Abstract

Objective To assess the experience, views and opinions of rheumatology providers at Veterans Affairs (VA) facilities about rheumatic disease healthcare issues during the COVID‐19 pandemic. Methods We performed an anonymized cross‐sectional survey, conducted from April 16 to May 18, 2020, of VA rheumatology providers. We assessed provider perspective on COVID‐19 issues and resilience. Results Of the 153 eligible VA rheumatologists, 103 (67%) completed the survey. A significant proportion of providers reported ≥50% increase related to COVID‐19 in visits by: (1) telephone, 53%; (2) video‐based VA video connect (VVC), 44%; and (3) clinical video telehealth (CVT) with a facilitator, 29%. A majority of the responders were somewhat or very comfortable with technology for providing healthcare to established patients during COVID‐19 pandemic using: (1) telephone, 87%; (2) VA video connect (VVC), 64%; and (3) in‐person visits, 54%. A smaller proportion were comfortable with technology providing healthcare to new patients. At least 65% of rheumatologists considered telephone visits appropriate for established patients with gout, osteoporosis, polymyalgia rheumatica, stable rheumatoid arthritis, stable spondyloarthritis, or osteoarthritis; 32% reported a rheumatology medication shortage. Adjusted for age, sex and ethnicity, high provider resilience was associated with significantly higher odds ratio (OR) of comfort with technology for telephone (OR, 3.1 (95% CI, 1.1‐9.7)) and VVC visits for new patients (OR, 4.7 (95% CI, 1.4‐15.7)). Conclusions A better understanding of COVID‐19 rheumatic disease healthcare issues using a health‐system approach can better inform providers, improve provider satisfaction and have positive effects on the care of Veterans with rheumatic disease.

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

“…Majority of clinicians in our study reported that they had access to telephone and video consultations; however, it appears that they were underutilised particularly for new patient consultations. This pattern was also observed in veteran affairs study from the USA [12]. Nevertheless, telephone consultations were the preferred choice for follow-up consultations in our study.…”

“…Tele-rheumatology had been sporadically used in a small proportion of rheumatology patients in the pre-COVID era [10]. However, available data suggest that clinicians have adapted to this new way of consulting their patients and telemedicine is now widely used in rheumatology practice in many parts of the world [11,12]. Majority of clinicians in our study reported that they had access to telephone and video consultations; however, it appears that they were underutilised particularly for new patient consultations.…”

Evaluation of Tele-rheumatology during the COVID-19 Pandemic in Asian Population: A Pilot Study

“…The first national report on rheumatologists in Veterans Affairs (VA) also supports the consideration that rheumatological disorders are suitable for virtual phone visits during the COVID-19 pandemic. This study also reports that preference of telemedicine care and in-person can coexist in an ideal world [ 9 ]. In a meta-analysis, the author recorded five feasibility studies, 14 on efficacy, and 9 on satisfaction rates for various synchronous and asynchronous consultations.…”

“…Telemedicine has possible application in rheumatology, and over previous years, many studies have discussed its applicability and feasibility. In addition, telemedicine is a practical alternative to in-person follow-up rheumatology visits during the covid-19 pandemic [ 9 ]. The promising studies in this field are so encouraging that the term “tele-rheumatology” is being used increasingly now [ 10 ].…”

Evaluation of a Non-Face-to-Face Multidisciplinary Health Care Model in a Population with Rheumatoid Arthritis Vulnerable to COVID-19 in a Health Emergency Situation

“…In addition, 52.7% of patients considered it useful. In some settings [ 37 ], when evaluating HCP, it was found that two-thirds or more of the rheumatologists chose telephone follow-up for stable RA and other stable clinical rheumatological conditions. Going in depth, other researchers [ 4 ] found that during the first peak of the pandemic, the patients’ level of satisfaction with teleconsultation (including telephone) was high in proportion to their educational level, and the doctor’s satisfaction was greater when the patient had ICT management skills.…”