Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study.

Objectives: To understand the impact of the coronavirus disease 2019 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory musculoskeletal (MSK) conditions. Methods: Three established cohorts that included individuals with axial SpA, psoriatic arthritis and MSK pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semistructured interviews. Results: A total of 1054 people (45% female, median age 59 years) were included in the quantitative analyses. Qualitative data included 447 free-text questionnaire responses and 23 interviews. A total of 57% of respondents had tried to access care since the start of the UK national lockdown. More than a quarter reported being unable to book any type of healthcare appointment. General practice appointments were less likely to be delayed or cancelled compared with hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinically vulnerable were associated with a greater likelihood of attempting to access healthcare. People not in work, those reporting anxiety or depression and poorer quality of life were less likely to be satisfied with remotely delivered healthcare. Participants valued clear, timely and transparent care pathways across primary care and specialist services. While remote consultations were convenient for some, in-person appointments enabled physical assessment and facilitated the development and maintenance of clinical relationships with care providers. Conclusions: We identified patient factors that predict access to and satisfaction with care and aspects of care that patients value. This is important to inform remobilisation of rheumatology services to better meet the needs of patients.

How COVID-19 Impacted Older Adult Walking Group Members in Scotland: A Mixed-Methods Study

Scotland has enacted strict social distancing and stay-at-home policies during the COVID-19 pandemic, at times prohibiting outdoor group-based physical activity. This mixed-method study examined the changing role of older adult walking groups in North East Scotland around the first lockdown and how restrictions impacted members’ well-being. Three consecutive surveys were posted or emailed to members of the Grampian 50+ Network over summer 2020, with questions about social contact, loneliness, well-being, physical activity, public health messages, help-seeking behavior, and socio-demographics. 346 members completed the June survey, with 268 (83%) returning the follow-up survey in July, and 258 (80%) in August. Twenty participants (selection criteria - gender and geographic location) participated in repeated semi-structured interviews. Participants were, on average, 72±7 years old (range: 58-90), retired (94%), and women (80%). Participants reported missing in-person interaction from not regularly meeting with their walking group. Groups adapted to stay-at-home measures by using technology (i.e. videoconferencing/text/email/telephone) to maintain relationships. Easing restrictions required groups to modify format, location and size. Concerns about safe transport, mask-wearing, maintaining social distance (2m/6ft), and potential lack of socialisation emerged as barriers for future engagement. While, participants generally expressed confidence in the Scottish Government’s pandemic response and public health messaging, they expressed dissatisfaction that ‘over-70s’ were grouped together. Findings suggest that these walking group members fared well and were adaptive in response to the pandemic. Promoting group-based opportunities for physical activity and social interaction remain vital for the health and well-being of older adults in the near and long term.

The effect of COVID-19 public health restrictions on the health of people with musculoskeletal conditions and symptoms: the CONTAIN study.

OBJECTIVE: To quantify the change in quality of life, disease-specific indicators, health and lifestyle before and during the COVID-19 pandemic among people with musculoskeletal diagnoses and symptoms. METHODS: We undertook an additional follow-up of two existing UK registers involving people with axial spondyloarthritis (axSpA) or psoriatic arthritis (PsA) and participants in a trial in the UK who had regional pain and were identified at high risk of developing chronic widespread pain. Participants completed the study questionnaire between July and December 2020, throughout which time there were public health restrictions in place. RESULTS: The number of people taking part in the study was 1054 (596 axSpA, 162 PsA, 296 regional pain). In comparison with their previous (pre-pandemic) assessment, there was an age-adjusted significant, small decrease in quality of life measured by EQ-5D [-0.020 (95% CI -0.030, -0.009)] overall and across all population groups examined. This was primarily related to poorer mental health and pain. There was a small increase in fibromyalgia symptoms, but a small decrease in sleep problems. There was a small deterioration in axSpA disease activity, and disease-specific quality of life and anxiety in PsA participants. Predictors of poor quality of life were similar pre- and during the pandemic. The effect of lockdown on activity differed according to age, gender and deprivation. CONCLUSION: Important lessons include focusing on addressing anxiety and providing enhanced support for self-management in the absence of normal health care being available, and awareness that all population groups are likely to be affected.