Survey sheds light on rheumatology provider experiences during COVID-19 pandemic
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
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