Healthcare use in individuals with rheumatoid arthritis during the COVID-19 pandemic and beyond: A cohort study in three nations of the UK

Objectives

We aimed to estimate how rheumatology healthcare use has changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes in healthcare use.

Methods

Using three primary and secondary care electronic health record datasets in England (with the approval of NHS England), Scotland, and Wales, we identified individuals 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), April 2019-November 2023 (England)) and quantified changes using interrupted time-series analysis. We used logistic regression to determine characteristics associated with having fewer appointments compared to 2019.

Results

We identified 145,065, 3,813 and 13,637 individuals 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 all other specialist outpatient appointments have recovered in all nations. Ethnic minorities, those living in more deprived areas and urban areas had fewer appointments after the start of the pandemic compared to 2019.

Conclusion

For the first time, we compared healthcare use across three UK nations and found that rheumatology outpatient appointments had not recovered to pre-COVID-19 pandemic levels, particularly in Scotland and England. Certain patient groups had fewer appointments during the study period.

Key messages

• Rheumatology outpatient appointments remain below pre-pandemic levels, particularly in England and Scotland, unlike other specialties.

• Ethnic minorities, deprived communities, and urban residents had fewer rheumatology appointments post-pandemic than in 2019. Rheumatology services need data-driven strategies to provide better support, tailored to local community needs.