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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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Leese J, Therrien S, Ramachandran S, Backman CL, Ma JK, Koehn CL, Hoens AM, English K, Davidson E, McQuitty S, Gavin J, Adams J, Li LC. Decision-Making Around COVID-19 Public Health Measures and Implications for Self-Care Activities: Experiences of Persons With Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2024; 76:140-152. [PMID: 37870115 DOI: 10.1002/acr.25262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
OBJECTIVE We aimed to advance understanding of how persons with rheumatoid arthritis (RA) experience decision-making about adopting public health measures during the COVID-19 pandemic. METHODS Persons living with RA partnered throughout this nested qualitative study. One-to-one semistructured telephone interviews were conducted with participants with RA between December 2020 and December 2021. They were strategically sampled from a randomized controlled trial that was underway to test a physical activity counseling intervention. Analysis was guided by reflexive thematic analysis. RESULTS Thirty-nine participants (aged 26-86 years; 36 women) in British Columbia, Canada were interviewed. We developed three themes. Participants described how their decision-making about public health measures related to 1) "upholding moral values of togetherness" because decisions were intertwined with moral values of neighborliness and reciprocity. Some adapted their self-care routines to uphold these moral values; 2) "relational autonomy-supports and challenges," because they sometimes felt supported and undermined in different relational settings (eg, by family, local community, or provincial government); and 3) "differing trust in information sources," in which decisions were shaped by the degree of faith they had in various information sources, including their rheumatologists. CONCLUSION Across themes, experiences of decision-making about public health measures during the pandemic were embedded with moral concepts of solidarity, autonomy, and trust, with implications for how persons with RA chose and sustained their self-care activities. Insights gained help sensitize researchers and clinicians to moral issues experienced by persons with RA, which may inform support for self-care activities during and after the pandemic.
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Affiliation(s)
- Jenny Leese
- Arthritis Research Canada, Vancouver, British Columbia, and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Smruthi Ramachandran
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Catherine L Backman
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jasmin K Ma
- Arthritis Research Canada and University of British Columbia and International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
| | - Cheryl L Koehn
- Arthritis Consumer Experts, Vancouver, British Columbia, Canada
| | - Alison M Hoens
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly English
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Eileen Davidson
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Shanon McQuitty
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | | | - Jo Adams
- University of Southampton, Southampton, UK
| | - Linda C Li
- Arthritis Research Canada and University of British Columbia, Vancouver, British Columbia, Canada
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Sweeney M, Carpenter L, de Souza S, Chaplin H, Tung H, Caton E, Galloway J, Cope A, Yates M, Nikiphorou E, Norton S. Ongoing shielding behavior one year post COVID-19: results from a longitudinal study of patients with inflammatory arthritis. Rheumatol Int 2024; 44:67-71. [PMID: 37691070 PMCID: PMC10766775 DOI: 10.1007/s00296-023-05430-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/10/2023] [Indexed: 09/12/2023]
Abstract
Many patients with inflammatory arthritis (IA) were instructed to shield during the COVID-19 pandemic. Despite the ending of lockdowns and vaccination, large proportions of IA patients were continuing to shield when it is no longer needed. Given the detrimental effects of shielding on mental and physical health, understanding the rates and reasons for shielding is needed to help clinicians advise patients accordingly. This study was a 12-month prospective study following participants with IA during the COVID-19 pandemic. The proportions of IA patients shielding at each time point were calculated. Additionally, regressions and odds ratios for shielding were determined to assess medication type, mental health, and risk perception. While the extent of shielding fluctuated over the year of lockdowns, nearly all IA patients (93.5%) were still engaging in some shielding in 2021, with nearly half (43%) still shielding most or all of the time. Medications that were previously considered higher risk were not significantly associated with higher rates of shielding (OR = 1.60, p = 0.29), but greater symptoms of depression in June 2020 (OR = 1.07, p = 0.03) was both associated with increased the odds of shielding in June 2021. The high rates of IA patients continuing to shield in 2021 put more strain on patients and professionals as social isolation is linked with worsening mental and physical health, as well as greater difficulty with self-management. It is important for clinicians to be aware of this trend to ease the stress on patients.
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Affiliation(s)
- Melissa Sweeney
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK.
| | - Lewis Carpenter
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Hema Chaplin
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK
| | - Hsiu Tung
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK
| | - Emma Caton
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Andrew Cope
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Sam Norton
- Health Psychology Section, Health Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Guy's Hospital, 5thFloor, Bermondsey Wing, Great Maze Pond, London, UK
- Centre for Rheumatic Diseases, King's College London, London, UK
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Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Gonzalez-Gonzalez V, Beltran-Aguilar VM, Arias-Peralta AG, De Avila-Gonzalez N, Guajardo-Jauregui N. Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic. Clin Rheumatol 2023; 42:2677-2690. [PMID: 36627529 PMCID: PMC9838353 DOI: 10.1007/s10067-022-06486-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/10/2022] [Accepted: 12/12/2022] [Indexed: 01/12/2023]
Abstract
Rheumatic autoimmune diseases are associated with a myriad of comorbidities. Of particular importance due to their morbimortality are cardiovascular diseases. COVID-19 greatly impacted the world population in many different areas. Patients with rheumatic diseases had to face changes in their healthcare, in addition to unemployment, a decrease in physical activity, social isolation, and lack of access to certain medications. This review summarizes the impact of COVID-19 pandemic on cardiovascular risk factors, comorbidities, and unhealthy behaviors in patients with rheumatic inflammatory autoimmune diseases, particularly focused on rheumatoid arthritis and systemic lupus erythematosus. Searches were carried out in MEDLINE/PubMed and Scopus from August to December 2022. Four reviewers screened the title and abstract of retrieved records. Potentially eligible reports were then reviewed in full text. Differences were reconciled by either consensus or discussion with an external reviewer. During the COVID-19 pandemic, patients with rheumatic diseases showed an increase in the prevalence of mental health disorders (43.2-57.7%), reduced physical activity (56.8%), and a worsening in eating behaviors. Alcohol intake increased (18.2%), especially in early phases of the pandemic. Smoking prevalence decreased (28.2%). Dyslipidemia and hypertension showed no changes. The pandemic and lockdown affected rheumatic patients not only in disease-related characteristics but in the prevalence of their cardiovascular comorbidities and risk factors. Lifestyle changes, such as healthy eating, physical activity, and optimal management of their rheumatic diseases and comorbidities, are essential to manage the long-lasting consequences of the COVID-19 outbreak. Key Points • During the COVID-19 pandemic, anxiety, depression, sedentarism, obesity, and a worsening in eating behaviors increased. •Patients with rheumatic diseases and comorbidities have worse clinical outcomes and a higher cardiovascular disease burden than those without them. •Comparative studies are necessary to precisely elucidate the pandemic's impact on the prevalence of cardiovascular disease, risk factors, and comorbidities in patients with rheumatoid arthritis and systemic lupus erythematosus.
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Affiliation(s)
- Dionicio A Galarza-Delgado
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jose R Azpiri-Lopez
- Division of Cardiology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Gonzalitos S/N, 64460, Monterrey, Nuevo León, Mexico.
| | - Iris J Colunga-Pedraza
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Jesus Alberto Cardenas-de la Garza
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Valeria Gonzalez-Gonzalez
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Victor M Beltran-Aguilar
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Angel G Arias-Peralta
- Division of Cardiology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Francisco I. Madero y Gonzalitos S/N, 64460, Monterrey, Nuevo León, Mexico
| | - Natalia De Avila-Gonzalez
- Division of Rheumatology, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
| | - Natalia Guajardo-Jauregui
- Internal Medicine Department, Hospital Universitario "Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico
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Ng JH, Halinski C, Nair D, Diefenbach MA. Impact of COVID-19 on Disease Self-management Among Patients With Advanced CKD: A Qualitative Study. Kidney Med 2023; 5:100689. [PMID: 37360218 PMCID: PMC10268812 DOI: 10.1016/j.xkme.2023.100689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/30/2023] [Indexed: 06/28/2023] Open
Abstract
Rationale & Objective Patients with advanced chronic kidney disease (CKD) and their care partners experienced decreased access to care, and worse physical and emotional health during the Coronavirus Disease-19 (COVID-19) pandemic. Few studies have explored how COVID-19-related challenges affected disease self-management among those with advanced chronic kidney disease (CKD) and their care partners. Leventhal's self-regulation model offers a comprehensive framework for understanding disease self-management through the interplay of cognitive beliefs, emotional reactions and social influences. The study aims to examine the impact of COVID-19 on self-management activities among patients with CKD and care partners. Study Design Qualitative study. Setting & Participants Adults with advanced CKD, including dialysis and transplant recipients, and their carepartners. Analytical Approach Thematic Analysis. Results Among 42 participants, 12 had stage 4 CKD, 5 had stage 5 CKD, 6 were receiving in-center hemodialysis, 5 had a kidney transplant, and 14 were care partners. We identified 4 patient-related themes with corresponding subthemes related to the impact of COVID-19 on self-management: 1) cognitive understanding that COVID-19 is an additional health threat to existing kidney disease, 2) heightened anxiety and vulnerability driven by perceived risk, 3) coping with isolation through virtual interactions with healthcare services and social circles, 4) increased protective behaviors to maximize survival. Three care partner-related themes emerged: 1) hypervigilance in family care and protection, 2) interaction with health system and adaptations to self-management, and 3) increased intensity in caregiving role to facilitate patient self-management. Limitations The qualitative study design limits the ability to generate generalizable data. Grouping patients with Stage 3 and 4 CKD, in-center hemodialysis, and kidney transplants together limited our ability to examine self-management challenges specific to each treatment requirement. Conclusions When faced with the COVID-19 pandemic, patients with CKD and their care partners experienced heightened vulnerability and thus increased cautionary activities to maximize survival. Our study provides the groundwork for future interventions to help patients and care partners live with kidney disease during future crises.
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Affiliation(s)
- Jia H. Ng
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Division of Kidney Diseases and Hypertension, Northwell Health
| | - Candice Halinski
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Division of Kidney Diseases and Hypertension, Northwell Health
| | - Devika Nair
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Michael A. Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
- Institute of Health System Science, Feinstein Institutes for Medical Research
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Al Faraidy K, Akbar M, Shehri M, Aljarallah M, Abdin Hussein G, Dashti R, Al Qudaimi A, Al Nouri F, Awan Z, Essam A, Emara A. Multizonal observational study conducted by clinical practitioners on evolocumab use in subjects with hyperlipidemia in Saudi Arabia and Kuwait: Results from the ZERBINI study. PLoS One 2023; 18:e0278821. [PMID: 36662739 PMCID: PMC9858091 DOI: 10.1371/journal.pone.0278821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 10/14/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Dyslipidemia is a prevalent condition with significant morbidity and mortality across the world, including in the Arabian Gulf. The present study aimed to describe the characteristics of patients receiving evolocumab in clinical practice. METHODS ZERBINI was a multi-country, observational, retrospective/prospective study of subjects receiving evolocumab as part of routine clinical management of their hyperlipidemia. This regional publication reports on adult participants from Saudi Arabia and Kuwait who have had ≥1 dose of evolocumab before enrollment and ≤6 months' prior exposure to evolocumab. Patient characteristics and treatment persistence data were collected in addition to baseline and follow-up data up to 12 months post-evolocumab initiation. RESULTS Overall, 225 patients were included from two sites, Saudi Arabia (N = 155) and Kuwait (N = 70). Mean age was comparable across sites and most patients had baseline coronary artery disease and/or hypertension. Baseline LDL-C levels (mean ± SD 3.6 ± 1.4 mmol/L in Saudi Arabia, 3.1 ± 1.4 mmol/L in Kuwait) were reduced by approximately 57%-62% in the first 6 months after evolocumab initiation (1.5 ± 1.2 mmol/L in Saudi Arabia [n = 63], 1.2 ± 0.8 mmol/L in Kuwait [n = 28]). This decrease was maintained over the 12-month follow-up period. Most patients achieved ACC 2018 LDL-C goals (<1.8 mmol/L; 74.6% in Saudi Arabia, 93.1% in Kuwait) and ESC 2019 LDL-C goals (<1.4 mmol/L; 66.7% in Saudi Arabia, 75.9% in Kuwait) in the first 6 months after evolocumab initiation. Medication persistence with evolocumab was high (up to 90.7%). Evolocumab had a favorable safety profile and no treatment-emergent adverse events were observed at either site. CONCLUSION Evolocumab is an effective lipid-lowering treatment in local populations. LDL-C goal achievement is increased when evolocumab is added to background lipid-lowering therapy with high tolerability and persistence. Long-term follow-up and large-scale data are needed to further support these observations.
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Affiliation(s)
- Khalid Al Faraidy
- KFMMC Cardiac Center, Interventional Cardiologist, King Fahd Military Medical Complex, Dharan, Saudi Arabia
| | - Mousa Akbar
- Cardiology Unit, Sabah Hospital, Kuwait City, Kuwait
| | - Mohamed Shehri
- Cardiac Center Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Gamal Abdin Hussein
- Adult Cardiology Department, Cardiac Center North West Armed Forces King Salman Hospital, Tabuk, Saudi Arabia
| | - Raja Dashti
- Sabah Al-Ahmad Cardiac Center, Amiri Hospital, Kuwait City, Kuwait
| | | | - Fahad Al Nouri
- Cardiovascular Prevention Unit, Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Zuhier Awan
- King Abdulaziz University, Clinical Biochemistry Jeddah University, Jeddah, Saudi Arabia
| | - Ahmed Essam
- Medical Affair Department, Amgen Middle East, Dubai, United Arab of Emirates
| | - Alaa Emara
- Medical Department, Amgen Saudi, Saudi Arabia
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Gómez-Restrepo C, Cepeda M, Torrey WC, Suarez-Obando F, Uribe-Restrepo JM, Park S, Acosta MPJ, Camblor PM, Castro SM, Aguilera-Cruz J, González L, Chaparro N, Gómez-Gamez AM, Bell K, Marsch LA. Perceived access to general and mental healthcare in primary care in Colombia during COVID-19: A cross-sectional study. Front Public Health 2022; 10:896318. [PMID: 36159257 PMCID: PMC9490130 DOI: 10.3389/fpubh.2022.896318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/19/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction The COVID-19 pandemic has had an impact both in general and mental healthcare, challenged the health systems worldwide, and affected their capacity to deliver essential health services. We aimed to describe perceived changes in ease of access to general and mental healthcare among patients with a diagnosis of depression and/or unhealthy alcohol use in Colombia. Methods This study is embedded in the DIADA project, a multicenter implementation research study aimed at evaluating the integration of mental healthcare in primary care in Colombia. Between November 2020 and August 2021, we conducted a COVID-19 pandemic impact assessment in a cohort of participants with newly diagnosed depression and/or unhealthy alcohol use part of DIADA project. We assessed the ease of access and factors related to perceived ease of access to general or mental healthcare, during the COVID-19 pandemic. Results 836 participants completed the COVID-19 pandemic impact assessment. About 30% of participants considered their mental health to be worse during the pandemic and 84.3% perceived access to general healthcare to be worse during the pandemic. Most of participants (85.8%) were unable to assess access to mental health services, but a significant proportion considered it to be worse. Experiencing worse ease of access to general healthcare was more frequent among women, patients with diagnosis of depression, and patients with comorbidities. Experiencing worse ease of access to mental healthcare was more frequent among patients aged between 30 and 49.9 years, from socioeconomic status between 4 and 6, affiliated to the contributive social security regime, attending urban study sites, and those who perceived their mental health was worse during the pandemic. Discussion Despite the overall perception of worse mental health during the pandemic, the use of mental healthcare was low compared to general healthcare. Ease of access was perceived to be worse compared to pre-pandemic. Ease of access and access were affected by geographical study site, socioeconomic status, age and gender. Our findings highlight the need for improved communication between patients and institutions, tailored strategies to adapt the healthcare provision to patients' characteristics, and continued efforts to strengthen the role of mental healthcare provision in primary care.
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Affiliation(s)
- Carlos Gómez-Restrepo
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Magda Cepeda
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia,*Correspondence: Magda Cepeda
| | - William C. Torrey
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | | | | | - Sena Park
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - María Paula Jassir Acosta
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Pablo Martínez Camblor
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Sergio M. Castro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jeny Aguilera-Cruz
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Lilian González
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Natalia Chaparro
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Ana María Gómez-Gamez
- Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Kathleen Bell
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, United States
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8
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Experiences during the COVID-19 Pandemic among People with Inflammatory Arthritis: “Reopening of Society Is Harder than Lock-Down”—A Qualitative Interview Study. Vaccines (Basel) 2022; 10:vaccines10070982. [PMID: 35891146 PMCID: PMC9318035 DOI: 10.3390/vaccines10070982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/17/2022] [Accepted: 06/17/2022] [Indexed: 02/04/2023] Open
Abstract
People with inflammatory arthritis (IA) treated with immunosuppressive disease-modifying anti-rheumatic drugs (DMARDs) were initially considered to have an increased risk of severe illness from the SARS-CoV-2 virus compared to the general population. The aim of this study was to explore how people with IA experienced restrictions during the pandemic and the possible impact of vaccination on their protection against COVID-19 and their everyday lives. Nineteen people with IA were interviewed in May–August 2021; shortly thereafter they were enrolled in the Danish national COVID-19 vaccination programme. Concurrently, society gradually reopened after a national complete lockdown. The analysis was inspired by inductive qualitative content analysis. Participants expressed a lack of targeted information on the specific risk associated with IA if they contracted COVID-19. They had to define their own level of daily-life restrictions to protect themselves and their families. They were impacted by inconsistent announcements by the authorities, and some expressed concerns regarding the potential influence of DMARDs on vaccine effectiveness. A societal spirit of being “in this together” emerged through the lockdown, and some were concerned that the reduced level of restrictions in the reopened society would put them at higher risk of a COVID-19 infection and force them to continue self-isolating.
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9
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Sweeney M, Carpenter L, de Souza S, Chaplin H, Tung H, Caton E, Galloway J, Cope A, Yates M, Nikiphorou E, Norton S. The impact of COVID-19 on clinical care, self-management and mental health of patients with inflammatory arthritis. Rheumatol Adv Pract 2022; 6:rkab095. [PMID: 35043091 PMCID: PMC8690299 DOI: 10.1093/rap/rkab095] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/28/2021] [Indexed: 01/17/2023] Open
Abstract
Objectives The coronavirus disease 2019 (COVID-19) lockdown and ongoing restrictions in the UK affected access to clinical care, self-management and mental health for many patients with inflammatory arthritis. The aim of this study was to determine the impact of lockdown on inflammatory arthritis clinical care, self-management, disease outcomes and mental health. Methods In total, 338 people with inflammatory arthritis participated in a prospective study, completing a series of online questionnaires. The questionnaires assessed demographics, inflammatory arthritis condition and management, clinical care, quality of life and mental health. Visual analogue scales (VASs) were completed at each assessment. Linear regression, controlling for confounders, was conducted to determine factors associated with physical and mental health outcomes. Results More than half of participants reported worsening VAS by >10 points for patient global assessment (PGA), pain, fatigue and emotional distress during the initial lockdown. Changes in clinical care were associated with worse PGA (b = 8.95, P = 0.01), pain (b = 7.13, P = 0.05), fatigue (b = 17.01, P < 0.01) and emotional distress (b = 12.78, P < 0.01). Emotional distress and depression were also associated with worse outcomes in PGA, pain and fatigue, whereas loneliness was not. In contrast, physical activity seemed to mitigate these effects. Loneliness did not show any associations with outcomes. Over time, these effects decreased or disappeared. Conclusion Changes to clinical care owing to lockdown were associated with worse disease outcomes in patients with inflammatory arthritis. There has also been a clear impact on mental health, with possibly complex relationships between mental health and psychosocial factors. Physical activity emerged as a key influence on disease outcomes and mental health.
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Affiliation(s)
- Melissa Sweeney
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Lewis Carpenter
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Hema Chaplin
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Hsiu Tung
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Emma Caton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - James Galloway
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Andrew Cope
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Mark Yates
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Elena Nikiphorou
- Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King's College London.,Centre for Rheumatic Diseases, King's College London, Weston Education Centre, Cutcombe Road, London, UK
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