University of Pennsylvania, Philadelphia.
University of Alabama at Birmingham.
Arthritis Care Res (Hoboken). 2021 Aug;73(8):1153-1161. doi: 10.1002/acr.24626. Epub 2021 Jul 6.
The effect of the COVID-19 pandemic on community-based rheumatology care and the use of telehealth is unclear. We undertook this study to investigate the impact of the pandemic on rheumatology care delivery in a large community practice-based network.
Using a community practice-based rheumatologist network, we examined trends in in-person versus telehealth visits versus canceled visits in 3 time periods: pre-COVID-19, COVID-19 transition (6 weeks beginning March 23, 2020), and post-COVID-19 transition (May-August). In the transition period, we compared patients who received in-person care versus telehealth visits versus those who cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits.
Pre-COVID-19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by ~300 providers practicing in 92 offices. This number decreased substantially (24.6% reduction) during the COVID-19 transition period for in-person visits but rebounded to pre-COVID-19 levels during the post-COVID-19 transition. There were almost no telehealth visits pre-COVID-19, but telehealth increased substantially during the COVID-19 transition (41.4% of all follow-up visits) and slightly decreased during the post-COVID-19 transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with a greater likelihood of canceling visits. Most factors were also associated with a lower likelihood of having telehealth versus in-office visits. Patients living further from the rheumatologists' office were more likely to use telehealth.
COVID-19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID-19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.
COVID-19 大流行对基于社区的风湿病护理和远程医疗的影响尚不清楚。我们进行这项研究是为了调查大流行对大型社区实践为基础的网络中风湿病护理的影响。
我们使用社区实践为基础的风湿病医生网络，检查了 3 个时间段内面对面、远程医疗和取消就诊的趋势：COVID-19 前、COVID-19 过渡期（2020 年 3 月 23 日开始的 6 周）和 COVID-19 后过渡期。在过渡期间，我们比较了接受面对面治疗、远程医疗或取消所有就诊的患者。我们使用多变量逻辑回归来确定与取消或远程医疗就诊相关的因素。
COVID-19 前，在由约 300 名医生在 92 个诊室中治疗的 60002 名独特风湿病患者中，每周有 7075 次就诊。在 COVID-19 过渡期，面对面就诊的数量大幅减少（减少 24.6%），但在 COVID-19 后过渡期恢复到 COVID-19 前水平。COVID-19 前几乎没有远程医疗就诊，但在 COVID-19 过渡期远程医疗就诊大幅增加（所有随访就诊的 41.4%），在 COVID-19 后过渡期略有减少（就诊的 27.7%）。年龄较大、女性、黑人和西班牙裔/拉丁裔种族/民族、较低的社会经济地位和农村居住与取消就诊的可能性更大相关。大多数因素也与进行远程医疗而不是办公室就诊的可能性降低相关。距离风湿病医生办公室较远的患者更有可能使用远程医疗。
COVID-19 导致风湿病护理出现重大中断；这些中断仅部分被远程医疗使用的增加所抵消，并且不成比例地影响了少数族裔和社会经济地位较低的患者。在 COVID-19 时代，远程医疗继续成为风湿病实践的重要组成部分，但一些弱势群体在获得医疗服务方面存在差距。
