Disruptions in Rheumatology Care and the Rise of Telehealth in Response to the COVID19 Pandemic in a Community Practice‐Based Network

George, Michael; Danila, Maria I.; Watrous, Daniel; Reddy, Shanmugapriya; Alper, Jeffrey; Xie, Fenglong; Nowell, W. Benjamin; Kallich, Joel; Clinton, Cassie; Saag, Kenneth G.; Curtis, Jeffrey R.

BACKGROUND: The effect of the COVID19 pandemic on community‐based rheumatology care and use of telehealth is unclear. METHODS: Using a community practice‐based rheumatologist network, we examined trends in in‐person vs. telehealth visits vs. canceled visits in three time periods: pre‐COVID19, COVID19‐Transition (6‐weeks beginning 3/23/20), and post‐COVID19‐Transition (May‐August). In the Transition period, we compared patients who received in‐person care vs. telehealth visits vs. cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits. RESULTS: Pre‐COVID19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by approximately 300 providers practicing in 92 offices. This decreased substantially (24.6% reduction) during COVID19‐Transition period for in‐person but rebounded to pre‐COVID19 levels during post‐COVID19 transition. There were almost no telehealth visits pre‐COVID19, but telehealth increased substantially during the COVID19‐Transition (41.4% of all follow‐up visits) and slightly decreased during post‐COVID19‐Transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with greater likelihood of cancelling visits. Most factors were also associated with a lower likelihood of having telehealth vs. in‐office visits. Patients living further from the rheumatologists’ office were more likely to use telehealth. CONCLUSION: COVID19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID‐19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.