Changes in Service Delivery and Access to Rheumatologists Before and During the COVID-19 Pandemic in a Canadian Universal Healthcare Setting.

OBJECTIVE: To describe changes in service delivery and access to rheumatologists before and during the coronavirus disease 2019 (COVID-19) pandemic periods. METHODS: We conducted a population-based study in Ontario, Canada. Patient visits with rheumatologists were ascertained using billing claims data. Contact with rheumatologists was defined separately by the type of patient encounter (including office visits, telemedicine visits, and new patient consultations). Changes in the total weekly volume of encounters and monthly rates after COVID-19 public health measures were imposed were compared to expected baseline rates determined before pandemic onset (March 17, 2020). RESULTS: In the year prior to the pandemic, there were 289,202 patients (of which 96,955 were new consults) seen by 239 rheumatologists. In the 1 year following the pandemic onset, there were 276,686 patients (of which 86,553 were new consults) seen by 247 rheumatologists. In March 2020, there was an immediate 75.9% decrease in outpatient office visits and a rapid rise in telemedicine visits. By September 2021, 49.7% of patient encounters remained telemedicine visits. For new patient consultations, there was an immediate 50% decrease in visits at the pandemic onset, with 54.8% diverted to telemedicine visits in the first year of the pandemic versus 37.4% by September 2021. New rheumatology consultation rates continued decreasing over the study period. CONCLUSION: Rheumatology care delivery has shifted due to the pandemic, with telemedicine increasing sharply early in the pandemic and persisting over time. The pandemic also negatively affected access to rheumatologists, resulting in fewer new consultations and raising concerns for potential delays to diagnosis.

Conspiracy Theories, Psychological Distress, and Sympathy for Violent Radicalization in Young Adults during the COVID-19 Pandemic: A Cross-Sectional Study.

The COVID-19 pandemic has spread uncertainty, promoted psychological distress, and fueled interpersonal conflict. The concomitant upsurge in endorsement of COVID-19 conspiracy theories is worrisome because they are associated with both non-adherence to public health guidelines and intention to commit violence. This study investigates associations between endorsement of COVID-19 conspiracy theories, support for violent radicalization (VR) and psychological distress among young adults in Canada. We hypothesized that (a) endorsement of COVID-19 conspiracy theories is positively associated with support for VR, and (b) psychological distress modifies the relationship between COVID-19 conspiracy theories and support for VR. A total of 6003 participants aged 18-35 years old residing in four major Canadian cities completed an online survey between 16 October 2020 and 17 November 2020, that included questions about endorsement of COVID-19 conspiracy theories, support for VR, psychological distress, and socio-economic status. Endorsement of conspiracy theories was associated with support for VR in multivariate regression (ß = 0.88, 95% confidence interval (CI) 0.80-0.96). There is a significant interaction effect between endorsement of COVID-19 conspiracy theories and psychological distress (ß = 0.49, 95% CI 0.40-0.57). The magnitude of the association was stronger in individuals reporting high psychological distress (ß = 1.36, 95% CI 1.26-1.46) compared to those reporting low psychological distress (ß = 0.47, 95% CI 0.35-0.59). The association between endorsement of COVID-19 conspiracy theories and VR represents a public health challenge requiring immediate attention. The interaction with psychological distress suggests that policy efforts should combine communication and psychological strategies to mitigate the legitimation of violence.