medwireNews: A survey of Veterans Affairs (VA) rheumatology consortium members has given greater insight into the experiences and opinions of rheumatology providers during the COVID-19 pandemic.
In April 2020, the survey was sent to 153 eligible VA rheumatologists of whom 67% responded.
Jasvinder Singh, from the University of Alabama at Birmingham, USA, presented the findings in a poster at the ACR Convergence 2020 virtual meeting.
He reported that, during the pandemic, at least 65% of rheumatologists considered telephone consultations the most appropriate method for established patients with gout, osteoporosis, polymyalgia rheumatica, stable rheumatoid arthritis (RA), stable spondyloarthritis, or osteoarthritis.
Approximately one-third of respondents said that using the video-based VA video connect (VVC) service would be their preferred method for seeing patients with local musculoskeletal conditions, tendinitis, RA with active medication (DMARD/biologic) changes, and patients with stable lupus, scleroderma, or vasculitis. However, between 41% and 53% preferred an in-person visit for people with lupus, scleroderma, vasculitis with immunosuppressive or glucocorticoid dose changes, and RA or spondyloarthritis with active medication (DMARD/biologic) changes.
In line with these findings, 53% of participants reported a 50% or greater increase in telephone visits, 44% reported an increase in VVC-based visits, and 29% reported an increase in clinical video telehealth (CVT) visits with a facilitator.
The majority of respondents said they were somewhat or very comfortable using the telephone (87%) or VVC (64%) to provide healthcare to established patients but a lower proportion (54%) were comfortable with in-person visits.
Just 25% and 34% said they were somewhat or very comfortable providing healthcare for new patients via the telephone or VVC, respectively, with a larger proportion (58%) preferring in-person visits.
The researchers found that a high level of provider resilience, which reflects stress coping ability and was measured on the Connor-Davidson Resilience Scale, was associated with a significantly higher likelihood of being comfortable with the technology needed for telephone (odds ratio [OR]=3.1) or VVC visits (OR=4.7).
In terms of medication and vaccination, Singh noted that 45% of participants reported a shortage in hydroxychloroquine and 15% reported and shortage in interleukin (IL)-6 inhibitors, and the majority said they would not withhold hydroxychloroquine (95%) or sulfasalazine (74%) treatment for a live COVID-19 vaccine.
However, 66% said they would withhold methotrexate or leflunomide and 52% would withhold glucocorticoids of 20 mg/day or higher for 2 weeks or less if a live vaccine was available; and higher proportions would withhold tumor necrosis factor (TNF) inhibitors (85%), anti-IL-17/23 biologics (82%), Janus kinase inhibitors (78%), belimumab (77%), non-TNF biologics (76%), and immunosuppressive drugs such as azathioprine (64%) for a period of 3 to 8 weeks.
In addition, at least 50% of participants said they would not withhold any of these drugs for a killed COVID-19 vaccine, while 25% said they would be willing to pause treatment for less than 2 weeks.
Singh concluded that although provider opinions might change as the COVID-19 epidemic evolves, the study gives “[a] better understanding of COVID-19 rheumatic disease healthcare issues using a health-system approach” and can “improve the care of Veterans with rheumatic disease and their providers.”
The study results are also published in Arthritis Care & Research.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
11 November 2020: The coronavirus pandemic is affecting all healthcare professionals across the globe. Medicine Matters’ focus, in this difficult time, is the dissemination of the latest data to support you in your research and clinical practice, based on the scientific literature. We will update the information we provide on the site, as the data are published. However, please refer to your own professional and governmental guidelines for the latest guidance in your own country.
ACR Convergence virtual meeting; 5–9 November 2020
Arthritis Care Res 2020; DOI:10.1002/acr.24487