Outpatient hospital attendances in people with rheumatoid arthritis during the COVID-19 pandemic and beyond: A cohort study in three nations of the UK

Abstract

Objectives: We aimed to estimate how rheumatology outpatient hospital attendances have changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes.

Methods: Using three primary and secondary care electronic health record datasets in England (with the approval of NHS England), Scotland, and Wales, we identified people with a diagnosis of rheumatoid arthritis (RA) before 01/04/2019. We determined the proportion of people with rheumatology hospital outpatient appointments each month (April 2019-December 2022 (Wales and Scotland), November 2023 (England)) and quantified changes using interrupted time-series analysis. We used logistic regression to determine characteristics associated with having fewer appointments compared with 2019.

Results: We identified 145 065, 3,813 and 13 637 people coded with RA in England, Scotland, and Wales, respectively. At the start of the COVID-19 pandemic the number of rheumatology outpatient appointments dropped sharply across all nations. In England and Scotland, the percentage of monthly appointments has continued to decline. In Wales, while there was a gradual recovery, rheumatology services have not returned to pre-pandemic levels. In contrast, the number of appointments for other specialties has recovered in all nations. People with no rheumatology outpatient appointments were more often aged over 80, male, and living in rural areas. Ethnic minorities, those living in more deprived, and urban areas had fewer appointments after the start of the pandemic compared with 2019.

Conclusion: For the first time, we compared healthcare use across three UK nations and found rheumatology outpatient appointments had not recovered to pre-COVID-19 pandemic levels, particularly in Scotland and England.

Keywords: Rheumatoid Arthritis; delivery of health care; inequalities; observational studies; organisation of health care.