Background/Purpose: To assess the experience, current practices, views and opinions of rheumatology providers at Veterans Affairs (VA) facilities for the care of the patients with rheumatic disease during the COVID-19 pandemic in 2020-21

Methods: We performed an anonymized cross-sectional survey to assess VA rheumatology provider perspective on COVID-19 healthcare issues and resilience, from November 2020 to January 2021, and compare practices to the baseline survey from April-May 2020 (Singh JA, ACR 2020).

Results: Of the 153 eligible VA rheumatologists, 114 (75%) completed the survey. The mean CD-RISC2 score was 6.8 (SD, 1.11; range 0-8; higher=more resilient), higher than the original survey score of 6.35 (SD, 1.26; p=0.004 and p=0.008, respectively). The proportion of rheumatology providers who chose telephone or VVC as the best modality for follow-up of established patients varied widely across rheumatic diseases as follows (Figure 1): (1) gout, osteoporosis, polymyalgia rheumatica, or osteoarthritis (OA), 90-100%; (2) stable rheumatoid arthritis (RA), stable spondyloarthritis (SpA) or stable lupus, scleroderma or vasculitis, 73-88%; (3) local musculoskeletal conditions or tendinitis, 45-46%; (4) lupus, scleroderma, vasculitis, RA or SpA with immunosuppressive, glucocorticoid or disease-modifying antirheumatic disease drug (DMARD)/biologic) changes, 9-20% (Figure 1).

Compared to the original survey, the use of telephone visits was lower by 10-20%, while VVC and in-person were higher by about 10%.

Comfort with Technology: Established Patients. Provider comfort with technology was essentially unchanged compared to the original survey: (1) telephone visits, 82%; (2) VVC visits, 63%. 33% were comfortable with CVT visits, with no previous comparator question (Figure 2). New patients. Provider comfort with technology increased compared to the original survey: telephone visits, 40% vs. 25% (p=0.019); VVC visits, 47% vs. 34% (p=0.051; Figure 2).

Comfort with the Quality of Outpatient Visits and Improvement in Comfort Since June 2020 (no previous data/comparator): Providers comfort with the quality of clinical encounter for established vs. new patients was as follows (Figure 3): (1) telephone, 63% vs. 27%; (2) VVC, 63% vs. 47%; and (3) CVT 32% vs. 27%. Improvement in comfort with the quality of the clinical encounter since June 2020 for established vs. new patients was as follows: telephone, 66% vs. 46%; VVC, 67% vs. 58%; and CVT, 31% vs. 27%.

Adjusted for age, sex, and ethnicity, high provider resilience was significantly associated with a higher odds ratio (OR) of comfort with technology and comfort with the quality of the VVC visit: (1) established patient, 1.71 (95% CI, 0.67-4.40) and 4.13 (95% CI, 1.49-11.44); (2) new patient, 2.79 (95% CI, 1.11-7.05); and 2.69 (95% CI, 1.06-6.82), respectively.

Conclusion: Utilization of and comfort with video visits during the COVID-19 pandemic increased over time among VA rheumatology providers, also associated with provider resilience

ACR Meeting Abstracts - https://acrabstracts.org/abstract/rheumatic-disease-management-by-resilient-rheumatology-providers-in-covid-19-pandemic-a-national-veterans-affairs-follow-up-survey-assessing-provider-practice-and-views-since-june-2020/