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O22 Evaluating the impact of COVID-19 on patient access to rheumatology services, medication and future care: a nationwide study of more than 2,000 patients

Abstract Background/Aims  COVID-19 has had significant impacts upon the delivery of rheumatology care in the UK. To date, there is little data specifically addressing how care has been disrupted and the impact upon patient attitudes and beliefs. Herein, we describe the results of a national study investigating how COVID-19 has; (1) reduced access to services; (2) altered treatment and drug monitoring; (3) impacted on clinic follow-up; (4) changed patient beliefs regarding ongoing/future care. Methods  We conducted an online survey of patients attending rheumatology clinics in the UK. Questions were developed by clinicians with input from patient charities and four expert patients. The survey was hosted online between 8 September and 8 October 2020. Results  In total, 2,054 patients completed the survey and the average number of rheumatic conditions each patient reported was 1.98±1.38 with the most common being; rheumatoid arthritis (48%), lupus (20%), Sjogren’s syndrome (19%), fibromyalgia (15%) and vasculitis (8%). More than half (57%) were told to shield, whilst 10% decided to shield of their own accord. Compared with before the pandemic, 57% felt it was difficult/very difficult to contact their rheumatologist. Regarding treatment, 15% reported difficulty obtaining their usual medication. Less than half (45%) of patients continued medication as previously and had no problem accessing it, although 21% said their usual drug monitoring had been discontinued. Overall, 3% stopped their treatment of their own accord. In all, 26% said their appointments in rheumatology clinics had been cancelled and they did not know when they would be seen again (4% reported no change in their outpatient follow-up). Prior to the pandemic, 13% of patients had received a telephone consultation, however, since the pandemic 60% had received one. Just 19% felt it was easy to be honest with their clinician via telephone. Only 33% were satisfied with the current level of care, 43% reported their rheumatology care was worse than pre-pandemic and 38% of patients felt they needed to see their rheumatologist but could not get an appointment. Over half (57%) of patients expressed worries about their future care. If offered an appointment in the next few months 66% said they would prefer it be face-to-face. Conclusion  To our knowledge, this study is the largest survey of patient experiences of the COVID-19 pandemic under rheumatological care anywhere in the world. We found more than half of patients were told to shield and one-in-ten decided to shield without being directly told to do so. Less than half of patients maintained relatively good access to their usual medication without necessary monitoring in many cases. In particular, patients express high levels of concern about their future care. These high levels of disruption indicate the importance of maintaining routine rheumatology services during the ongoing pandemic. Disclosure  C. Wincup: Grants/research support; CW has received research funding from Versus Arthritis, LUPUS UK and the British Society for Rheumatology. R. Amarnani: None. I. Giles: None.


Background/Aims
The COVID-19 pandemic is associated with significant levels of psychological distress, affecting both those with and without the COVID infection. In the general population, COVID-19 has most notably affected those who are female, in younger age groups, black Asian and ethnic minority groups (BAME). A significant proportion of rheumatology patients are 'clinically extremely vulnerable', classed as high-risk of COVID under current national guidance. While it is recognised that extra precautionary measures in this group, such as stringent social distancing (shielding), adversely impacts these patients mental health, other risk factors, for patients with rheumatic disease whose health related quality of life (HRQoL) scores are most impacted, have not being explored. In our large cohort of rheumatology patients under secondary care follow up at the Royal Wolverhampton Trust we assessed HRQoL scores at the 4-week point following the introduction of lockdown measures.

Conclusion
We found significantly worse mental health scores in female patients, BAME patients and those patients that had suffered the COVID infection. Clinically extremely vulnerable patients had worse mental and physical health scores. There was no significant difference in mental health scores between patients in different ages groups, while, as might be expected, physical health scores were significantly worse in the older age groups. These data indicate a focus on adverse psychological consequences in specific patient groups may be required for future increases in COVID infection rates. Further work on the evolving pattern of psychological responses to the pandemic in rheumatic disease is required. Disclosure N. Cleaton: None. J. Bateman: None.

Methods
This single-center observational study included 118 children suffering from various rheumatic diseases and receiving therapy with antirheumatic drugs and biological agents. In this research, we analyzed the incidence of CIVID-19 and the frequency of documented contact with SARS-CoV-2 in the period from 01.03.2020 to 11.10.2020 (32 weeks). The results were analyzed using descriptive statistics.

Methods
We conducted an online survey of patients attending rheumatology clinics in the UK. Questions were developed by clinicians with input from patient charities and four expert patients. The survey was hosted online between 8 September and 8 October 2020.

Results
In total, 2,054 patients completed the survey and the average number of rheumatic conditions each patient reported was 1.98AE1.38 with the i10 ORAL ABSTRACT PRESENTATIONS most common being; rheumatoid arthritis (48%), lupus (20%), Sjogren's syndrome (19%), fibromyalgia (15%) and vasculitis (8%). More than half (57%) were told to shield, whilst 10% decided to shield of their own accord. Compared with before the pandemic, 57% felt it was difficult/very difficult to contact their rheumatologist. Regarding treatment, 15% reported difficulty obtaining their usual medication. Less than half (45%) of patients continued medication as previously and had no problem accessing it, although 21% said their usual drug monitoring had been discontinued. Overall, 3% stopped their treatment of their own accord. In all, 26% said their appointments in rheumatology clinics had been cancelled and they did not know when they would be seen again (4% reported no change in their outpatient follow-up). Prior to the pandemic, 13% of patients had received a telephone consultation, however, since the pandemic 60% had received one. Just 19% felt it was easy to be honest with their clinician via telephone. Only 33% were satisfied with the current level of care, 43% reported their rheumatology care was worse than prepandemic and 38% of patients felt they needed to see their rheumatologist but could not get an appointment. Over half (57%) of patients expressed worries about their future care. If offered an appointment in the next few months 66% said they would prefer it be face-to-face.

Conclusion
To our knowledge, this study is the largest survey of patient experiences of the COVID-19 pandemic under rheumatological care anywhere in the world. We found more than half of patients were told to shield and one-in-ten decided to shield without being directly told to do so. Less than half of patients maintained relatively good access to their usual medication without necessary monitoring in many cases. In particular, patients express high levels of concern about their future care. These high levels of disruption indicate the importance of maintaining routine rheumatology services during the ongoing pandemic. Background/Aims COVID-19 has created numerous challenges for people globally. In the UK, few studies have reported poorer outcomes for certain ethnic populations. UK government introduced shielding guidance to protect the most vulnerable patients and this was in force for a number of months. However, shielding guidance was initially released only in English, which resulted in further disenfranchisement of the Black, Asian and Minority Ethnic community (BAME). We undertook an audit to understand experiences of shielding particularly in rheumatological BAME patients in multi-ethnic communities in 3 centres -Wolverhampton, Leicester and Oxford.

Methods
This study was approved in all three sites as an audit. Patients contacting rheumatology helpline or having routine consultations were included. Each centre aimed to recruit at least 20 patients. A questionnaire was developed to capture important data on shielding.
The study was conducted between May and June 2020 during the peak of the first wave of Covid 19.

Results
We recruited 79 patients into this audit, of these 54 were of BAME and 25 of Caucasian ethnicity with 17 males and 62 females. Rheumatoid Arthritis (RA) was the commonest diagnosis in 49 of these patients (62%) and these patients were older (median ages 56 vs. 46 years, p ¼ 0.14). BSR risk scoring algorithm was used to determine need for shielding (BSR score of 3 or more) -38 patients fell into this category. There was a significant difference between centres in patients stopping medications with patients from Leicester much more likely (p < 0.001).

Conclusion
Despite the small numbers, the data clearly suggest that BAME patients were less likely to understand the reasons for shielding, to follow shielding advice, and more likely to change their medications, thereby risking a flare. Addressing culturally competent educational needs and health equality for BAME rheumatology patients continues to remain a challenge.