Early experience and outcomes of telephoneand video consultations in rheumatology during firstwave of COVID-19

ABSTRACT

Background/AimsInflammatory arthritis (IA) patients have been identified as being atgreater risk of severe illness from COVID-19. It is likely that lockdownrestrictions enforced by the UK government in response to the COVID-19 pandemic, and subsequent changes made to healthcare provisions, could impact patients' abilities to effectively manage theircondition. The aim of this study was to qualitatively explore the impact of COVID-19 and lockdown on self-management behaviours andhealthcare provision in people with IA.MethodsSemi-structured interviews were conducted with 21 patients with IAfrom across the UK (as part of a larger longitudinal survey studyexploring the impact of COVID-19 on health-related quality of life forpeople with IA). Participants who gave consent for contact, followingthe completion of the baseline survey study, were approached to takepart in the qualitative interviews. The interview schedule wasdeveloped with a Patient Research Partner and consisted of eightmain questions to explore participants' experiences of the COVID-19pandemic, including the impact of COVID-19 on their self-management behaviours and access to healthcare services. The interviewswere conducted via telephone and were recorded and transcribedbefore being analysed using inductive thematic analysis.ResultsParticipants were aged between 24-72 (mean age 50.0, SD 15.6) andwere mostly female (71%) and White British (86%). Four main themeswere identified impact of COVID-19 on medication adherence, impactof COVID-19 on physical activity, impact of COVID-19 on diet, andimpact of COVID-19 on healthcare access. Subthemes focused onpositive and negative changes made to these areas, as well asbehaviours which remained consistent. Some participants expressedthat the lockdown period had enabled them to increase their physicalactivity, improve their diet and maintain their usual medicationregimen, whilst others noted that lockdown had had a negativeimpact on their self-management behaviours. For example, somepatients decided to discontinue their medication during the pandemicdue to concerns that it would make them more susceptible to severeconsequences from COVID-19. In relation to healthcare provision, themost commonly reported change was the introduction of telephoneappointments to replace face-to-face consultations. Several patientsfound the telephone appointments ineffective, especially if theirdisease was relatively uncontrolled. Nevertheless, participants understood why a remote approach had been implemented during thepandemic.ConclusionCOVID-19 has had an impact on patients' abilities to manage their IA.Healthcare professionals need to recognise the impact of COVID-19on patient self-management and healthcare provision to ensure thatadequate understanding and support is available to patients who mayhave inadequate disease control as a result.