POS1167 REVIEW OF THE IMPACT OF COVID-19 PANDEMIC ON RHEUMATOLOGY SERVICES AT A LARGE TERTIARY CARE CENTRE IN WALES, UK

Abstract

Background: COVID-19 pandemic had an unprecedented impact on the delivery of patient care. Rheumatology services had to rapidly adapt to virtual consultations at the onset of the pandemic. However, providing a high quality and effective service in a virtual setting can be challenging and therefore its prudent to do a formal review and gain patient feedback to ensure that these clinics are fit for purpose. Objectives: To evaluate the impact of first wave of COVID-19 pandemic on patients with autoimmune rheumatic conditions, assess delivery of rheumatology outpatient care and record patient feedback. Methods: This study included patients on the Rheumatology clinic lists between 3rd and 31st August 2020. An electronic survey questionnaire was developed and the survey link was sent to patients via a text message using secure IT platform. Data was collected on patient demographics, diagnosis, comorbidities, treatments, clinical/ laboratory confirmed COVID-19 diagnosis, treatment interruption, impact on work, personal protective measures taken and views on virtual consultations. Results: 307 patients responded with 287 complete responses. 73.1%(223) were female and 32.4% (99) were ≥65 years of age. Rheumatoid arthritis was the most common diagnosis 41.6%(127). Hypertension was the commonest comorbidity 21.4%(64) followed by Chronic lung disease 17.3%(52). 28.8%(85) were on Hydroxychloroquine, 26.7%(79) Methotrexate, 14.2%(42) Sulfasalazine and 13.2%(39) on Prednisolone. 22.3%(66) were on Biologics: Anti TNF 12.8%(38), Tocilizumab 3.7%(11) and Rituximab 3%(9). 52.6%(161) shielded, 16.9%(55) self-isolated and 30.3%(93) only maintained social distance. 197 patients self reported as being vulnerable but based on their treatment,only 167 patiemts met the clinically extremely vulnerable (CEV) criteria and all of those received government shielding letter. 3.6%(11) had lab confirmed COVID-19, 3.2%(10) had clinically suspected COVID-19 infection. 14.3% (43) had their treatment interrupted. 4.6%(14) were unable to work from home or maintain social distancing at work. 59.8%(182) had face-to-face consultation changed to virtual. 63.2%(189) were satisfied, 28%(84) neutral and 8.7%(26) reported dissatisfaction with their consultation. 50.5%(153) were happy to continue with virtual consultation but with an option of face to face only if necessary.For consultations post COVID-19, 59.4%(182) preferred a mixture of face to face and virtual appointments. Conclusion: Majority of our patients seem happy with virtual consultations as long as they are assured of a face-to-face consultation if needed. A minority(8.7%) however, were dissatisfied. Some of the suggestions were, use of video consultations and improvement in communication before the virtual appointments. Our survey also shows that our patients have adapted well to virtual consultations and many are keen to have virtual consultation in the longer term. In our survey, only 6.8%(21) patients reported definite or clinically suspected COVID-19. Possible explanations for this include strict compliance with government advice on social distancing/shielding and limited testing at the onset of the pandemic. More patients assumed themselves to be clinically CEV than those who were actually CEV based on their treatment which is not surprising because of high level of anxiety among patients due to rapidly spreading pandemic and multiple sources of information. This feedback provides useful data which will help us to plan the delivery of rheumatology services post COVID-19 pandemic. While face-to-face patient contact is needed for comprehensive disease assessment, teaching and training, a model for the future is likely to include a combination of face-to-face and virtual consultations. This could allow a greater capacity to see new patients and reduce waiting lists. Patients with uncomplicated and stable disease could be followed up in virtual clinics. There is also a need to formally incorportate the virtual consultations into the curriculum for Rheumatology trainees.