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Silverthorne CA, Jones B, Brooke M, Coates LC, Orme J, Robson JC, Tillett W, Dures E. Qualitative interview study of rheumatology patients' experiences of COVID-19 shielding to explore the physical and psychological impact and identify associated support needs. BMJ Open 2024; 14:e075871. [PMID: 38653512 PMCID: PMC11043751 DOI: 10.1136/bmjopen-2023-075871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 03/07/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE Many clinically extremely vulnerable rheumatology patients have only recently ceased shielding from COVID-19, while some continue to minimise in-person contact. The objective of this study was to understand the impact of shielding and associated support needs in patients with rheumatic conditions and to understand how rheumatology teams can meet these needs both currently and in future pandemics. DESIGN, PARTICIPANTS AND SETTING The study was conducted in the Southwest of England using a case-study design. The participants were 15 patients with rheumatic conditions who were advised to shield and/or chose to shield at any time during the COVID-19 pandemic. METHODS Qualitative data collected via telephone and online semi-structured interviews and analysed using reflexive thematic analysis. RESULTS Fifteen interviews were conducted. Three main themes represent the data:'Just shove them over there in the corner' captures changes in patients' self-perception. They felt different to most other people, vulnerable and left behind. The initial sense of shock was followed by a sense of loss as changes became long term.'A long and lonely road' captures patients' psychological isolation due to a perceived lack of understanding and support. This included having to prove their health status and justify their shielding behaviours, which impacted their relationships. At times, they felt abandoned by their healthcare providers.'You can't just flip a switch' captures the difficulty of getting back to pre-pandemic normal after shielding. Patients did not recognise themselves physically and mentally. They wanted to collaborate with health professionals and identified the need for specific guidance to support their recovery. CONCLUSION Patients are dealing with lasting physical and mental effects from shielding and consequences of delayed healthcare. Health professionals need time and resources to ask about patients' well-being, identify their health needs and refer/signpost to appropriate sources of support.
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Affiliation(s)
- Christine A Silverthorne
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- University of the West of England, Bristol, UK
| | - Bethan Jones
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- University of the West of England, Bristol, UK
| | | | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jen Orme
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- University of the West of England, Bristol, UK
| | - Joanna C Robson
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- University of the West of England, Bristol, UK
| | - William Tillett
- Royal United Hospitals, Bath, UK
- University of Bath, Bath, UK
| | - Emma Dures
- Academic Rheumatology, Bristol Royal Infirmary, Bristol, UK
- University of the West of England, Bristol, UK
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2
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Schlegel M, Bachmann S. Influence of the COVID-19 Pandemic on Medical Management and on Healthcare Delivery of Immune-Mediated Rheumatic and Musculoskeletal Diseases during the First Pandemic Period February to July 2020: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:596. [PMID: 38674242 PMCID: PMC11052197 DOI: 10.3390/medicina60040596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/01/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
(1) Background and Objectives: The COVID-19 pandemic influenced the management of patients with immune-mediated rheumatic and musculoskeletal diseases (imRMDs) in various ways. The goal of our systematic review was to determine the influence of the first period of the COVID-19 pandemic (February 2020 to July 2020) on the management of imRMDs regarding the availability of drugs, adherence to therapy and therapy changes and on healthcare delivery. (2) Materials and Methods: We conducted a systematic literature search of PubMed, Cochrane and Embase databases (carried out 20-26 October 2021), including studies with adult patients, on the influence of the COVID-19 pandemic on the management of imRMDs. There were no restrictions regarding to study design except for systematic reviews and case reports that were excluded as well as articles on the disease outcomes in case of SARS-CoV-2 infection. Two reviewers screened the studies for inclusion, and in case of disagreement, a consensus was reached after discussion. (3) Results: A total of 5969 potentially relevant studies were found, and after title, abstract and full-text screening, 34 studies were included with data from 182,746 patients and 2018 rheumatologists. The non-availability of drugs (the impossibility or increased difficulty to obtain a drug), e.g., hydroxychloroquine and tocilizumab, was frequent (in 16-69% of patients). Further, medication non-adherence was reported among patients with different imRMDs and between different drugs in 4-46% of patients. Changes to preexisting medication were reported in up to 33% of patients (e.g., reducing the dose of steroids or the cessation of biological disease-modifying anti-rheumatic drugs). Physical in-office consultations and laboratory testing decreased, and therefore, newly implemented remote consultations (particularly telemedicine) increased greatly, with an increase of up to 80%. (4) Conclusions: The COVID-19 pandemic influenced the management of imRMDs, especially at the beginning. The influences were wide-ranging, affecting the availability of pharmacies, adherence to medication or medication changes, avoidance of doctor visits and laboratory testing. Remote and telehealth consultations were newly implemented. These new forms of healthcare delivery should be spread and implemented worldwide to routine clinical practice to be ready for future pandemics. Every healthcare service provider treating patients with imRMDs should check with his IT provider how these new forms of visits can be used and how they are offered in daily clinical practice. Therefore, this is not only a digitalization topic but also an organization theme for hospitals or outpatient clinics.
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Affiliation(s)
- Marco Schlegel
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
| | - Stefan Bachmann
- Department of Rheumatology, Rehabilitations Zentrum Valens, Kliniken Valens, 7317 Valens, Switzerland
- Department of Geriatrics, Inselspital, Bern University Hospital, Faculty of Medicine, University of Bern, 3010 Bern, Switzerland
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3
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Dehghan Nayeri N, Fooladzadeh Dehghan M. Exploring the Experiences of Patients with Autoimmune Skin Diseases During the COVID-19 Pandemic. Adv Skin Wound Care 2024; 37:1-6. [PMID: 38506584 DOI: 10.1097/asw.0000000000000119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To explore the experiences of patients with an autoimmune disease during the COVID-19 pandemic. METHODS A total of 12 patients with autoimmune skin disease who were hospitalized in dermatology wards between 2021 and 2022 participated in this qualitative study. The researchers conducted in-depth, semi-structured interviews, which they analyzed using conventional content analysis. RESULTS Data analysis revealed three main themes: changes in mental/psychological status, social impacts and financial problems, and physical consequences. These patients reported changes in mental/psychological status as their most important experiences. CONCLUSIONS During a pandemic, it is important to manage the therapeutic course of patients who are at risk of infection, especially patients with autoimmune skin diseases, via appropriate planning.
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Affiliation(s)
- Nahid Dehghan Nayeri
- Nahid Dehghan Nayeri, PhD, is Professor, Nursing and Midwifery Care Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Fooladzadeh Dehghan, MSN, is Practical Nurse and PhD Candidate, Medical-Surgical Department, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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4
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Chen J, Feng H, Sun J, Jiang Y. Omicron wave during December 2022 - January 2023: access to pharmaceuticals and healthcare resources and impacts on health outcomes in Shenzhen, China. J Pharm Policy Pract 2024; 17:2306867. [PMID: 38357548 PMCID: PMC10866053 DOI: 10.1080/20523211.2024.2306867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Purpose This study described pharmaceutical and medical resource accessibility of COVID-19 treatment in Shenzhen, China during the peak of COVID-19 infection from December 2022 to January 2023, and examined its influence on clinical outcomes. Methods We surveyed Shenzhen residents on COVID-19-related topics using electronic questionnaires. We conducted descriptive statistical analyses and multiple regressions including logistic and Tobit models to explore the impacts of resource constraints on patient outcomes. Resource utilisation and attempts to seek medical care were also described for severity-stratified subgroups. Results 76.8% of respondents reported experiencing COVID-19 symptoms between December 7, 2022 and January 29, 2023. Of those who attempted to purchase medication, 72.8% reported drug shortage. 49% of those seeking medical treatment experienced difficulties. Compared with those who did not experience drug shortages, those who did had an odds ratio of 1.959 (95% CI: 1.159 ∼3.313) of presenting with moderate to severe symptoms. Compared with those without difficulties in seeking medical treatment, those who did had an average of 0.39 (95% CI: 0.110 ∼0.670) more days absent from work. Conclusion Shenzhen residents with COVID-19 symptoms from December 2022 to January 2023 experienced a certain degree of pharmaceutical and medical resource constraints, which might have compromised their prognosis.
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Affiliation(s)
- Jiayue Chen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Haisu Feng
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Jiatong Sun
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, People's Republic of China
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5
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Ghanbari‐Jahromi M, Kharazmi E, Bastani P, Shams M, Marzaleh MA, Amin Bahrami M. Factors disrupting the continuity of care for patients with chronic disease during the pandemics: A systematic review. Health Sci Rep 2024; 7:e1881. [PMID: 38384975 PMCID: PMC10879648 DOI: 10.1002/hsr2.1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/21/2023] [Accepted: 01/16/2024] [Indexed: 02/23/2024] Open
Abstract
Background and Aims Continuous routine care is necessary to prevent long-term complications of chronic diseases and improve patients' health conditions. This review study was conducted to determine the factors disrupting continuity of care for patients with chronic diseases during the pandemic. Methods All original articles published on factors disrupting continuity of care for patients with chronic disease during a pandemic between December 2019 and June 28, 2023, in PubMed, Web of Science, Scopus, and ProQuest databases were searched. Selection of articles, data extraction, and qualitative evaluation of articles (through STROBE and COREQ checklist) were done by two researchers separately. Data graphing form was used to extract the data of each study and then the data were classified by thematic analysis method. Results Out of 1708 articles reviewed from the databases, 22 were included. The factors disrupting the continuity of care for patients with chronic diseases during the epidemics were classified into two main categories: patient-side factors and health system-side factors. Patient-side factors including psychological, individual and social, disease-related, and health system-side factors including provider access, health system institutional, and infrastructural and financial problems were among the subcategories disrupting the continuity of care for patients with chronic diseases during the pandemic. Based on the studies, psychological factors and access to the provider were among the most frequent factors affecting the continuity of care for patients with chronic diseases in the pandemic. Conclusion Considering the factors disrupting the continuity of care and applying appropriate interventions based on them, can guarantee the continuity of providing services to chronic patients in health crises.
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Affiliation(s)
- Mohadeseh Ghanbari‐Jahromi
- Department of Healthcare Management, Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Erfan Kharazmi
- Department of Healthcare Management, Health Human Resources Research Center, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Peivand Bastani
- College of Business, Government and LawFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Mesbah Shams
- Department of Internal Medicine, Endocrinology and Metabolism Research CenterShiraz University of Medical SciencesShirazIran
| | - Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
| | - Mohammad Amin Bahrami
- Department of Healthcare Management, Health Human Resources Research Center, School of Health Management and Information SciencesShiraz University of Medical SciencesShirazIran
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6
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Hamidi Z, Jabraeili-Siahroud S, Taati-Alamdari Y, Aghbash PS, Shamekh A, Baghi HB. A comprehensive review of COVID-19 symptoms and treatments in the setting of autoimmune diseases. Virol J 2023; 20:1. [PMID: 36611166 PMCID: PMC9824943 DOI: 10.1186/s12985-023-01967-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
After the first reporting of the index case of Severe Acute Respiratory Syndrome (SARS)-CoV-2-associated disease at the end of December 2019, the virus spread quickly throughout the world, prompting the WHO on 11 March 2020 to declare the disease a global pandemic. The coronavirus disease 2019 (COVID-19) pandemic, raises concerns for all people, mainly for susceptible population. People with pre-existing diseases, especially individuals with autoimmune disorders, are more at the risk of SARS-CoV-2 infection because of compromised immune system due to frequent use of immunosuppressive drugs and steroids. Patients with autoimmune diseases and their physicians have concerns about these patients' healthcare, since they are at a higher risk for COVID-19 infection, may show severe complications of COVID-19, and may experience probable flares of their pre-existing disease. Even though there have been several studies discussing the relation between COVID-19 and various types of autoimmune diseases, it cannot be ascertained that all patients with autoimmune diseases experience more severe complications of COVID-19 and have more hospitalization or mortality rate. The situation depends on each patient's condition, such as the type and the severity of the underlying autoimmune disease and the kind of treatment they receive. In the present review, we have discussed the effects of COVID-19 pandemic on patients with different autoimmune diseases and their relative concerns about their treatments. As a result, we have reviewed further considerations that should be taken into account for these patients during the pandemic or when they are infected with COVID-19.
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Affiliation(s)
- Zahra Hamidi
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shaghaiegh Jabraeili-Siahroud
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yalda Taati-Alamdari
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parisa Shiri Aghbash
- grid.412888.f0000 0001 2174 8913Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Shamekh
- grid.412888.f0000 0001 2174 8913Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.412888.f0000 0001 2174 8913Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5165665931, Tabriz, Iran
| | - Hossein Bannazadeh Baghi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. .,Department of Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. .,Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O. Box 5165665931, Tabriz, Iran.
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7
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Ali SS, Wincup C. #RheumTwitter - the Rise of Social Media in Rheumatology: Research, Collaboration, Education, and Engagement. RHEUMATOLOGY AND IMMUNOLOGY RESEARCH 2022; 3:163-168. [PMID: 36879837 PMCID: PMC9984932 DOI: 10.2478/rir-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/30/2022] [Indexed: 06/18/2023]
Abstract
Social media broadly refers to an internet-based platform that allows for the online publication of content that is shared across a virtual community or network. Over recent years, there has been growing utilization of social media in the medical community. The field of rheumatology is no different. Social media allows for the sharing of information among rheumatologists, which can be useful in online education, disseminating research findings, forming new networks of collaborators, and discussing the latest advances in the field. However, there are several challenges facing clinicians using social media. As such, regulatory bodies have produced advisory codes of conduct to ensure better awareness concerning the appropriate use of social media among clinicians. In addition, clinicians (even those who do not use social media) need to be mindful of the fact that many patients will use these online platforms to find information, and with this comes the risk of false information. In this review, we highlight the benefits and challenges facing rheumatologists in relation to the world of social media.
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Affiliation(s)
- Sasha Saadia Ali
- King’s College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Chris Wincup
- King’s College Hospital NHS Trust, Denmark Hill, London, SE5 9RS, United Kingdom
- Department of Rheumatology, University College London, London, United Kingdom
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8
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Rutter M, Pearce FA, Lanyon PC. An uncomfortable truth: the long-term impact of COVID-19 on the clinician-patient relationship. Rheumatology (Oxford) 2022; 61:SI107-SI109. [PMID: 35325052 DOI: 10.1093/rheumatology/keac193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Megan Rutter
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
- National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), NHS Digital, Leeds, UK
| | - Fiona A Pearce
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
- National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), NHS Digital, Leeds, UK
| | - Peter C Lanyon
- Department of Lifespan and Population Health, School of Medicine, University of Nottingham
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham
- National Congenital Anomaly and Rare Disease Registration Service (NCARDRS), NHS Digital, Leeds, UK
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Daniels J, Rettie H. The Mental Health Impact of the COVID-19 Pandemic Second Wave on Shielders and Their Family Members. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127333. [PMID: 35742580 PMCID: PMC9223363 DOI: 10.3390/ijerph19127333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023]
Abstract
In March 2020, individuals shielding from coronavirus reported high rates of distress. This study investigated whether fear of contamination (FoC) and use of government-recommended behaviours (GRB; e.g., handwashing and wearing masks) were associated with psychological distress during February 2021. An online cross-sectional questionnaire assessed psychological distress in three groups (shielding self, shielding other/s, and control), and those shielding others also completed an adapted measure of health anxiety (α = 0.94). The sample (N = 723) was predominantly female (84%) with a mean age of 41.72 (SD = 15.15). Those shielding (self) demonstrated significantly higher rates of health anxiety and FoC in comparison to other groups (p < 0.001). The use of GRB was significantly lower in controls (p < 0.001), with no significant difference between the two shielding groups (p = 0.753). Rates of anxiety were higher when compared to March 2020 findings, except for controls. Hierarchical regressions indicated FoC and GRB accounted for 24% of variance in generalised anxiety (p < 0.001) and 28% in health anxiety, however, the latter was a non-significant predictor in final models. Those shielding themselves and others during the pandemic have experienced sustained levels of distress; special consideration must be given to those indirectly affected. Psychological interventions should account for realistic FoC and the impact of government-recommended health behaviours, as these factors are associated with distress in vulnerable groups and may extend beyond the pandemic. Future research should focus on longitudinal designs to monitor and better understand the clinical needs of those shielding, and those shielding others post-pandemic.
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Affiliation(s)
- Jo Daniels
- Department of Psychology, University of Bath, Bath BA2 7AY, UK;
- North Bristol NHS Trust, Bristol BS10 5NB, UK
- Correspondence:
| | - Hannah Rettie
- Department of Psychology, University of Bath, Bath BA2 7AY, UK;
- North Bristol NHS Trust, Bristol BS10 5NB, UK
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10
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Ramsey ML, Patel A, Sobotka LA, Lim W, Kirkpatrick RB, Han S, Hart PA, Krishna SG, Lara LF, Lee PJ, Conwell DL, Papachristou GI. Hospital Trends of Acute Pancreatitis During the Coronavirus Disease 2019 Pandemic. Pancreas 2022; 51:422-426. [PMID: 35835114 PMCID: PMC9394202 DOI: 10.1097/mpa.0000000000002046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 05/21/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The coronavirus disease 2019 pandemic led to changes in individuals' behaviors and healthcare delivery. We examined the impact of these changes on the rates and clinical course of acute pancreatitis (AP). METHODS Hospitalizations for AP from March 1 through August 31 in 2019 (baseline group) and the same period in 2020 (pandemic group) were retrospectively reviewed. Univariate and multivariate analyses were used for demographics and outcomes. RESULTS Two hundred eighty subjects (315 admissions) were identified in 2019 and 237 subjects (264 admissions) in 2020. Subjects in the pandemic group were more likely to have systemic inflammatory response syndrome (40% vs 25%, P < 0.01), pancreatic necrosis (14% vs 10%, P = 0.03), and persistent organ failure (17% vs 9%, P = 0.01) compared with prepandemic. There was no difference in etiology of AP. A multivariable model indicates that increased comorbidities, prior pancreatitis, pancreatic necrosis, and prescription of opiates at discharge were associated with 30-day readmissions during the pandemic. CONCLUSIONS Fewer patients were admitted for AP during the pandemic, suggesting that patients with milder symptoms avoided hospital interaction. Practices followed during the pandemic, especially avoidance of hospitalization and improved efficiency of hospital management, may reduce the burden of pancreatitis care in the future.
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Affiliation(s)
- Mitchell L. Ramsey
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Arsheya Patel
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Lindsay A. Sobotka
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Woobeen Lim
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH
| | - Robert B. Kirkpatrick
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Samuel Han
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Phil A. Hart
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Somashekar G. Krishna
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Luis F. Lara
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Peter J. Lee
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Darwin L. Conwell
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
| | - Georgios I. Papachristou
- From the Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center
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11
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Correa-Rodríguez M, Rueda-Medina B, Callejas-Rubio JL, Ríos-Fernández R, de la Hera-Fernández J, Ortego-Centeno N. The Relationship Between Health Literacy and Quality of Life, Attitudes and Perceptions of Covid-19 and Vaccination Among Patients with Systemic Autoimmune Diseases. Clin Nurs Res 2022; 31:981-990. [PMID: 35484917 DOI: 10.1177/10547738221090558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We aimed to evaluate health literacy in a population of patients with systemic autoimmune diseases (SAD), and to analyze their potential relationships with health-related quality of life (HRQoL), attitudes and beliefs of Covid-19 and vaccination, and perceptions of changes in medical care during the pandemic. A cross-sectional study was conducted among 395 patients (81.1% were living in Spain). An anonymous online survey was distributed to an online SAD association. Health literacy was measured using the European Health Literacy Survey Questionnaire (HLS-EU-Q16) and the SF-36 tool was used to assess HRQoL. More than half of patients (57.7%) have inadequate health literacy and the mean health literacy level was 9.63(5.66). Patients with inadequate health literacy levels presented the lowest HRQoL scores in all SF-36 domains (p < .001). Health literacy scores were positively correlated with all SF-36 domains (p < .001). The reservations to get vaccinated against Covid-19 were linked to health literacy level (p = 0.024). There are high levels of inadequate health literacy among patients with SAD and it is associated with worse HRQoL and risk attitudes about Covid-19 vaccination and medical care during the pandemic.
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Affiliation(s)
- María Correa-Rodríguez
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Blanca Rueda-Medina
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - José-Luis Callejas-Rubio
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Raquel Ríos-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Javier de la Hera-Fernández
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Systemic Autoimmune Diseases Unit, San Cecilio University Hospital, Granada, Spain
| | - Norberto Ortego-Centeno
- Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain.,Department of Medicine, University of Granada, Granada, Spain
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12
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So H, Chow E, Cheng IT, Lau SL, Li TK, Szeto CC, Tam LS. Use of telemedicine for follow-up of lupus nephritis in the COVID-19 outbreak: The 6-month results of a randomized controlled trial. Lupus 2022; 31:488-494. [PMID: 35254169 PMCID: PMC8902321 DOI: 10.1177/09612033221084515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aimed to evaluate the short-term patient satisfaction, compliance, disease control, and infection risk of telemedicine (TM) compared with standard in-person follow-up (FU) for patients with lupus nephritis (LN) during the COVID-19 pandemic. METHOD This was a single-center open-label randomized controlled study. Consecutive patients followed at the LN clinic were randomized to either TM or standard FU (SF) group in a 1:1 ratio. Patients in the TM group received FU via videoconferencing. SF group patients continued conventional in-person outpatient care. The 6-month data were compared and presented. RESULTS From June to December 2020, 122 patients were randomized (TM: 60, SF: 62) and had at least 2 FUs. There were no baseline differences, including SLEDAI-2k and proportion of patients in lupus low disease activity state (LLDAS), between the two groups except a higher physician global assessment score (PGA) in the TM group. After a mean FU of 19.8 ± 4.5 weeks, the overall patient satisfaction score was higher in the TM group. More patients in the TM group had hospitalization (15/60, 25.0% vs 7/62, 11.3%; p = .049) with higher baseline PGA (OR = 1.17; 95% CI, 1.08-1.26) being the independent predictor. The proportions of patients remained in LLDAS were similar in the two groups (TM: 75.0% vs SF: 74.2%, p = .919). None of the patients had COVID-19. CONCLUSIONS TM FU resulted in better patient satisfaction and similar short-term disease control in patients with LN compared to standard care. However, it was associated with more hospitalizations and might need to be complemented by in-person visits especially in patients with higher PGA.
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Affiliation(s)
- Ho So
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Evelyn Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Sze-Lok Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Cheuk-Chun Szeto
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
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13
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Beller J, Schäfers J, Haier J, Geyer S, Epping J. Trust in Healthcare during COVID-19 in Europe: vulnerable groups trust the least. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2022; 31:1-10. [PMID: 35345647 PMCID: PMC8944407 DOI: 10.1007/s10389-022-01705-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/06/2022] [Indexed: 12/30/2022]
Abstract
Aim We examined predictors of trust in the healthcare system during the COVID-19 pandemic in 27 European countries. Subjects and methods We used population-based data drawn from the Living, working and COVID-19 survey (N = 21,884, 52% female, ages 18 to 92 years) covering 27 European countries dated June and July 2020. Multilevel linear regression, linear regression, and regression-tree analyses were conducted. Results We found that most participants tended to trust the healthcare system, although a substantial part could still be classified as distrusting (approx. 21%). Multiple variables, including being middle-aged or of older age, being female, lower levels of education, unemployment, worse general health status, having income difficulties, having unmet needs for healthcare, no healthcare contact during the COVID-19 pandemic, higher mental distress, and loneliness, were significantly associated with lower levels of trust. Among these variables mental distress, income difficulties, and unmet needs for healthcare emerged as especially important and, across European regions and countries, consistent predictors for lower trust in the healthcare system during the COVID-19 pandemic. Conclusions Medically vulnerable subgroups, such as individuals with unmet healthcare needs, higher levels of mental distress, and older age, as well as people living in socially and economically vulnerable situations, such as higher levels of loneliness and financial difficulties, were the least trusting of the healthcare system during the COVID-19 pandemic. As these vulnerable subgroups are also at highest risk for contracting COVID-19 and experiencing negative COVID-19-related outcomes, more targeted prevention and intervention efforts should be implemented in these groups. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-022-01705-3.
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Affiliation(s)
- Johannes Beller
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jürgen Schäfers
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jörg Haier
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Siegfried Geyer
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Jelena Epping
- Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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14
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Patients’ perspectives of telemedicine appointments for psoriatic arthritis during the COVID-19 pandemic: results of a patient-driven pilot survey. BMC Rheumatol 2022; 6:13. [PMID: 35189975 PMCID: PMC8860501 DOI: 10.1186/s41927-021-00242-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/26/2021] [Indexed: 02/05/2023] Open
Abstract
Background Over recent years the lack of patient involvement in the design, set-up and implementation of clinical research studies has been well recognised; as such there has been a drive within research communities to increase patient participation. Patient perspectives on telemedicine differ widely, with variation in whether patients feel remote consultations are beneficial. By means of a patient-driven survey, we aimed to formally evaluate patient perspectives on its benefits and pitfalls, focusing on patients with psoriatic arthritis (PsA). Methods An e-survey was developed by two patient representatives on the BritPACT steering committee, with a view to determining unmet needs and the perceived impact on clinical care of virtual consultations amongst patients with PsA. Results 128 patients responded to the e-survey. 109 patients rated the effectiveness of their telemedicine appointment and, of these, 18% felt their virtual consultation was very/extremely effective compared to an in-clinic consultation and 49% felt it was somewhat/equally as effective; furthermore, 48% (51/107) felt that such virtual consultations would be of benefit to them after the pandemic. 36% of respondents felt their virtual consultation was not as effective as an in-clinic review. Themes identified from open-ended questions included the lack of visual cues, lack of physical examination and effect on rapport and ease of open communication as the main pitfalls of virtual consultations. Patients with well-controlled symptoms appeared more satisfied with remote reviews compared to those with active disease, though on the whole respondents recognised the benefits, such as saving travel time and costs. Those who had an established relationship with their health professional appeared less concerned regarding virtual consultations though a recurring view was that newly diagnosed patients should have in-clinic appointments to build rapport and improve symptom control at an early stage. Conclusions Overall patients’ perspectives on virtual consultations varied widely though patients with well-controlled symptoms and those who had a previously established relationship with their healthcare professionals and well-controlled disease appeared more satisfied with remote reviews. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-021-00242-y.
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15
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Morton L, Stelfox K, Beasley M, Jones GT, Macfarlane GJ, Murchie P, Paton J, Hollick R. Lessons from experiences of accessing healthcare during the pandemic for remobilizing rheumatology services: a national mixed methods study. Rheumatol Adv Pract 2022; 6:rkac013. [PMID: 35350717 PMCID: PMC8946474 DOI: 10.1093/rap/rkac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- LaKrista Morton
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Kevin Stelfox
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Marcus Beasley
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gareth T Jones
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Gary J Macfarlane
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
| | - Peter Murchie
- Centre of Academic Primary Care, University of Aberdeen, Aberdeen
| | - John Paton
- Scottish Patient Ambassador, National Rheumatoid Arthritis Society, Maidenhead, UK
| | - Rosemary Hollick
- Epidemiology Group
- Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
- Medical Research Council Versus Arthritis Centre for Musculoskeletal Health and Work
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16
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Sloan M, Harwood R, Gordon C, Bosley M, Lever E, Modi R, Blane M, Brimicombe J, Barrere C, Holloway L, Sutton S, D’Cruz D. Will 'the feeling of abandonment' remain? Persisting impacts of the Covid-19 pandemic on rheumatology patients and clinicians. Rheumatology (Oxford) 2022; 61:3723-3736. [PMID: 34995345 PMCID: PMC8755362 DOI: 10.1093/rheumatology/keab937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/15/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To better understand rheumatology patient and clinician pandemic-related experiences, medical relationships and behaviours in order to help identify the persisting impacts of the Covid-19 pandemic, and inform efforts to ameliorate the negative impacts and build-upon the positive ones. METHODS Rheumatology patients and clinicians completed surveys (Patients N = 1,543, Clinicians N = 111) and interviews (Patients N = 41, Clinicians N = 32) between April 2021 and August 2021. A cohort (N = 139) of systemic autoimmune rheumatic disease patients was also followed-up from March 2020 to April 2021. Analyses used sequential mixed methods. Pre-specified outcome measures included the Warwick-Edinburgh Mental wellbeing score (WEMWBS), satisfaction with care, and healthcare-behaviours. RESULTS We identified multiple ongoing pandemic-induced/increased barriers to receiving care. The percentage of patients agreeing they were medically supported reduced from 74.4% pre-pandemic to 39.7% during-pandemic. Ratings for medical support, medical-security and trust were significantly (p< 0.001) positively correlated with patient WEMWBS and healthcare-behaviours, and decreased during the pandemic. Healthcare-seeking was reduced, potentially long-term, including from patients feeling 'abandoned' by clinicians, and a 'burden' from Government messaging to protect the NHS. Blame and distrust were frequent, particularly between primary and secondary care, and towards the UK Government, whom <10% of clinicians felt had supported clinicians during the pandemic. Clinicians' efforts were reported to be impeded by inefficient administration systems, and chronic understaffing, suggestive of the pandemic having exposed and exacerbated existing healthcare-system weaknesses. CONCLUSION Without concerted action-such as rebuilding trust, improved administrative systems, and more support for clinicians-barriers to care and negative impacts of the pandemic on trust, medical relationships, medical-security and patient help-seeking may persist longer-term. TRIAL REGISTRATION This study is part of a pre-registered longitudinal multi-stage trial, the LISTEN study (ISRCTN-14966097), with later Covid-related additions registered in March 2021, including a pre-registered statistical analysis plan.
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Affiliation(s)
- Melanie Sloan
- Correspondence to: Melanie Sloan, Behavioural Science Group, Institute of Public Health University of Cambridge, Forvie Site Robinson Way, Cambridge CB2 0SR, UK. E-mail:
| | - Rupert Harwood
- Patient and Public Involvement in Rheumatology Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Caroline Gordon
- Rheumatology Research Group, Institute of inflammation and ageing, College of Medical and Dental Science, University of Birmingham, Birmingham
| | - Michael Bosley
- Patient and Public Involvement in Rheumatology Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | | | - Rakesh Modi
- Department of Public Health and Primary Care, School of Clinical Medicine
| | - Moira Blane
- Patient and Public Involvement in Rheumatology Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine
| | - Colette Barrere
- Patient and Public Involvement in Rheumatology Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Lynn Holloway
- Patient and Public Involvement in Rheumatology Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine
| | - David D’Cruz
- The Louise Coote Lupus Unit, Guy’s and St Thomas’, NHS Foundation Trust, London, UK
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17
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Cook C, Cox H, Fu X, Zhang Y, Stone JH, Choi HK, Wallace ZS. Perceived Risk and Associated Shielding Behaviors in Patients With Rheumatoid Arthritis During the Coronavirus 2019 Pandemic. ACR Open Rheumatol 2021; 3:834-841. [PMID: 34498436 PMCID: PMC8653208 DOI: 10.1002/acr2.11340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/12/2021] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To investigate the perceived risk of coronavirus disease 2019 (COVID-19) infection and outcomes as well as shielding practices among patients with rheumatoid arthritis (RA) during the COVID-19 pandemic. METHODS We surveyed participants with RA in a large health care system between July 16 and November 8, 2020. Participants reported RA treatment, COVID-19 risk perception, and shielding practices (eg, masks, social distancing, and quarantining). We examined the association of demographic and disease-specific factors with risk perception and the association of risk perception with shielding practices. RESULTS Of 494 participants, 195 (40%), 169 (34%), and 130 (26%) strongly agreed, agreed, or were uncertain/disagreed that their RA put them at higher risk for COVID-19 or poor outcomes, respectively. Younger age (odds ratio [OR]: 0.98), having a comorbidity (OR: 1.60), and biologic disease-modifying antirheumatic drug (bDMARD) use (OR: 1.75) were independently associated with a higher perceived risk. Among those who strongly agreed, agreed, or were uncertain/disagreed that they had greater risk, 165 (85%), 118 (70%), and 69 (53%), respectively, practiced all three shielding measures (P < 0.0001). Those who strongly agreed or agreed that they were at higher risk were more likely to use all three shielding practices (OR: 4.16 and 1.97, respectively). bDMARD use and glucocorticoid use were associated with using all three shielding measures (OR: 1.99 and 1.81, respectively). CONCLUSION Perception of COVID-19 risk among patients with RA varies substantially. Factors associated with perceived risk are different from those found to be associated with worse outcomes in observational studies. Greater perceived risk is associated with more strict shielding, which has implications for patient education and mental health.
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Affiliation(s)
- Claire Cook
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Huel Cox
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Xiaoqing Fu
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General HospitalBoston
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - John H. Stone
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Hyon K. Choi
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Zachary S. Wallace
- Division of Rheumatology, Allergy, and ImmunologyMassachusetts General Hospital and Harvard Medical SchoolBostonMassachusetts
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18
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Serban A, Mihai A, Dima A, Balaban DV, Jinga M, Jurcut C. The impact of the COVID-19 pandemic on patients with primary Sjögren syndrome. Rheumatol Int 2021; 41:1933-1940. [PMID: 34453578 PMCID: PMC8397857 DOI: 10.1007/s00296-021-04967-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
The aim of this study was to investigate the perspective of Romanian patients with Sjögren syndrome (SS) on various aspects of the disease during the SARS-CoV-2 outbreak, including both the impact of COVID-19 on the disease itself as well as the effects of vaccination against SARS-CoV-2 in this group of patients. The study is an online questionnaire-based survey. We received responses from 137 SS patients. Regarding the general emotional status, 33 patients (24.0%) and 47 patients (34.3%) declared to have been sadder/depressive and more agitated/anxious during the SARS-CoV2 outbreak, respectively. During the lockdown, 49 (33.7%) patients strictly and 77 patients (56.2%) did their best to respect the home isolation measures. The income was unchanged for most of the patients (94 patients, 68.6%). Regarding access to healthcare providers, 27 patients (18.7%) postponed the consultation for fear of getting SARS-CoV2. In our study group, 31 patients (22.6%) responded that they have had COVID-19. Only one patient was completely asymptomatic, while the most frequently declared symptom was weakness (84.0%). In 17 patients among the respondents (68%) the symptoms lasted for at least 2 weeks; the most frequent long-lasting symptoms were fatigue (40.0%) and weakness (36.0%). Out of all the respondents, 53 patients (41.4%) were vaccinated against SARS-CoV2 with at least one dose. After the first dose, the most prevalent side effect was pain at the site of injection (89.2%), followed by weakness (25.0%) and myalgias (21.4%). This information will be useful for developing special programs dedicated to SARS-CoV2 infection and vaccination in patients with SS and other autoimmune diseases.
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Affiliation(s)
- Augustin Serban
- Department of Internal Medicine, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - Ancuta Mihai
- Department of Internal Medicine, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - Alina Dima
- Department of Rheumatology, Colentina Clinical Hospital, Bucharest, Romania.
| | - Daniel Vasile Balaban
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Gastroenterology Department, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - Mariana Jinga
- Internal Medicine and Gastroenterology Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Gastroenterology Department, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
| | - Ciprian Jurcut
- Department of Internal Medicine, Dr. Carol Davila Central University Emergency Military Hospital, Bucharest, Romania
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19
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Sloan M, Lever E, Harwood R, Gordon C, Wincup C, Blane M, Brimicombe J, Lanyon P, Howard P, Sutton S, D'Cruz D, Naughton F. Telemedicine in rheumatology: A mixed methods study exploring acceptability, preferences and experiences among patients and clinicians. Rheumatology (Oxford) 2021; 61:2262-2274. [PMID: 34698822 PMCID: PMC8689882 DOI: 10.1093/rheumatology/keab796] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/20/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The Covid-19 pandemic necessitated a rapid global transition towards telemedicine; yet much remains unknown about telemedicine's acceptability and safety in rheumatology. To help address this gap and inform practice, this study investigated rheumatology patient and clinician experiences and views of telemedicine. METHODS Sequential mixed methodology combined analysis of surveys and in-depth interviews. Between and within-group differences in views of telemedicine were examined for patients and clinicians using t-tests. RESULTS Surveys (Patients n = 1,340, Clinicians n = 111) and interviews (Patients n = 31, Clinicians n = 29) were completed between April 2021 and July 2021. The majority of patients were from the UK (96%) and had inflammatory arthritis (32%) or lupus (32%). Patients and clinicians rated telemedicine as worse than face-to-face consultations in almost all categories, although >60% found it more convenient. Building trusting medical relationships and assessment accuracy were great concerns (93% of clinicians and 86% of patients rated telemedicine as worse than face-to-face for assessment accuracy). Telemedicine was perceived to have increased misdiagnoses, inequalities and barriers to accessing care. Participants reported highly disparate telemedicine delivery and responsiveness from primary and secondary care. Although rheumatology clinicians highlighted the importance of a quick response to flaring patients, only 55% of patients were confident that their rheumatology department would respond within 48 hours. CONCLUSION Findings indicate a preference for face-to-face consultations. Some negative experiences may be due to the pandemic rather than telemedicine specifically, although the risk of greater diagnostic inaccuracies using telemedicine is unlikely to be fully resolved. Training, choice, careful patient selection, and further consultation with clinicians and patients is required to increase telemedicine's acceptability and safety.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Elliott Lever
- Rheumatology department, Northwick Park Hospital, UK
| | - Rupert Harwood
- Patient and Public Involvement in lupus Research Group, Institute of Public Health, University of Cambridge, UK
| | - Caroline Gordon
- Rheumatology Research Group, Institute of inflammation and ageing, College of Medical and Dental Science, University of Birmingham, UK
| | - Chris Wincup
- Department of Rheumatology, University College London, UK
| | - Moira Blane
- Patient and Public Involvement in lupus Research Group, Institute of Public Health, University of Cambridge, UK
| | - James Brimicombe
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - Peter Lanyon
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, UK
| | - Paul Howard
- LUPUS UK, St James' House, Romford, Essex, UK
| | - Stephen Sutton
- Department of Public Health and Primary Care, School of Clinical Medicine, University of Cambridge, UK
| | - David D'Cruz
- The Louise Coote Lupus unit, Guy's and St Thomas', NHS foundation Trust, UK
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, UK
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20
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Lee WWH, Cheong YK, Teh CL, Wan SA, Chuah SL, Singh BSM. Impact of COVID-19 on hospitalization of patients with systemic lupus erythematosus (SLE). Clin Rheumatol 2021; 40:4775-4777. [PMID: 34510293 PMCID: PMC8435192 DOI: 10.1007/s10067-021-05920-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/06/2021] [Accepted: 09/07/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Wendy Wan Hui Lee
- Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia.
| | - Yaw Kiet Cheong
- Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Cheng Lay Teh
- Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Sharifah Aishah Wan
- Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
| | - Seow Lin Chuah
- Rheumatology Unit, Department of Medicine, Sarawak General Hospital, Sarawak, Malaysia
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21
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Sloan M, Gordon C, Lever E, Harwood R, Bosley MA, Pilling M, Brimicombe J, Naughton F, Blane M, Walia C, D’Cruz D. COVID-19 and shielding: experiences of UK patients with lupus and related diseases. Rheumatol Adv Pract 2021; 5:rkab003. [PMID: 33728396 PMCID: PMC7928599 DOI: 10.1093/rap/rkab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The shielding guidance in the UK for the clinically extremely vulnerable (CEV) commenced on 23 March 2020 in response to the coronavirus disease 2019 (COVID-19) pandemic. The purpose of this study was to explore the impact of the pandemic and shielding on patients with lupus and related systemic autoimmune rheumatic diseases (SARDs). METHODS This was a mixed-methods cohort study (n = 111) including pre-lockdown baseline surveys (March 2020), follow-up surveys (June 2020) and in-depth interviews during July 2020 (n = 25). RESULTS Most participants had a high level of anxiety regarding their mortality risk from COVID-19 and supported the concept of shielding. Shielding allocations and communications were perceived as inconsistently applied and delivered. More than half of those not classified as CEV reported feeling abandoned, at increased risk and with no support. Shielding communications increased feelings of being 'cared about', but also increased fear, and the 'vulnerable' labelling was perceived by some to damage social and self-identity. More than 80% of those classified as CEV stated that the classification and subsequent communications had changed their social-mixing behaviour. Despite many negative impacts of COVID-19 and shielding/lockdown being identified, including isolation, fear and reduced medical care, the quantitative data during the pandemic showed increases in most measures of wellbeing (which was low at both time points) from pre-lockdown, including reductions in the impact of fatigue and pain (P-values < 0.001). CONCLUSION Shielding classifications and communications were, in general, viewed positively, although they were perceived as inconsistently delivered and anxiety-provoking by some participants. More frequent positively framed communication and wellbeing support could benefit all SARD patients. Slower-paced lockdown lifestyles might confer health/wellbeing benefits for some people with chronic diseases.
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Affiliation(s)
- Melanie Sloan
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Science, University of Birmingham, Birmingham
| | - Elliott Lever
- Rheumatology Department, Northwick Park Hospital, London
| | - Rupert Harwood
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Michael A Bosley
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | - Mark Pilling
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - James Brimicombe
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge
| | - Felix Naughton
- Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich
| | - Moira Blane
- Patient and Public Involvement in Lupus Research Group, Institute of Public Health, University of Cambridge, Cambridge
| | | | - David D’Cruz
- The Louise Coote Lupus unit, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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