168. Vasculitis services during the COVID-19 pandemic: Characterising changing practices across the United Kingdom
Creators: name: Egan1, Allyson
name: Raashid Luqmani2
name: Basu3, Neil
name: Little4, Mark
name: Lanyon5, Peter
name: Hollick6, Rosemary
Publisher: name: Zenodo
Year: 2022

description: <strong>Background: </strong>The Vasculitis Outcomes In relation to Care Experience Study (VOICES), aims to understand the key patterns of service configuration underpinning effective care. An online questionnaire exploring the impact of COVID-19 pandemic on vasculitis service was conducted in collaboration with the UK and Ireland Vasculitis Society (UKIVAS) and the Scottish Systemic Vasculitis Network (SSVN). <strong>Methods: </strong>Vasculitis services across specialities in 87 UKIVAS sites, plus 11 Scottish regional health boards, were approached to complete the survey. 59 responses from 51 Trusts/Health Boards across Scotland (n=11), England (n=33), Wales (n=2), and Ireland (n=5) were collected. <strong>Results: </strong>During COVID, wait-times for GCA services capable of providing an appointment for newly suspected GCA within 3 working days pre-COVID, were largely maintained. In some services, a shift towards longer wait-times occurred, whilst in others, times improved. For suspected AAV, most services were able to maintain similar wait-times for new patients. During lockdown 41% held fewer regular clinics or cancelled clinics completely. 16% of services held fewer regular clinics but replaced these with general and urgent access/flare clinics. Some nurse led- clinics occurred more frequently, others reduced frequency or stopped. Triage processes included contacting all patients (by letter, email or telephone); patient triggered consultation (advice line or GP); and asynchronous consultation (clinical notes review, patient provided information, and blood tests) to identify those at high risk. During COVID-19, 94% undertook face to face (F2F) vasculitis consultations. Common indications for F2F consultation were relapse, diagnostic and disease activity assessment. 74% reported up to a quarter of remote consultations were converted to F2F consultation. Remote consultations were used to varying extents in existing vasculitis patients but much less commonly in new patients with suspected vasculitis. There was a rise in telephone and video consultations. Challenges for remote consultations include physical examination, urine analysis, phlebotomy, imaging, and reliable assessment of disease activity. Administrative and IT support for consultations could be an issue. Results indicated preference for this hybrid approach going forward. 38% of multidisciplinary meetings occurred less frequently, 21% were cancelled and 2% increased. Networks and vasculitis services roles during COVID-19 included case discussion, research, peer support, enablement of access to biologics, and educational updates for healthcare professionals. The pandemic impacted access to day-unit facilities for biologics and cytotoxic drug administration with 45% reported limited access for urgent cases only. Advice line activities increased significantly. Monitoring of immunosuppressants were similar in approximately 50% of respondents and reduced in others, see Figure 1. <strong>Conclusions:</strong> During COVID-19, service flexibility included rapid access clinics, and adaptation to remote consultations. Priorities going forward include support for remote care delivery, hybrid care pathways, and provision of biologic / cytotoxic drug delivery. Identifying core components of vasculitis services to be maintained in times of significant health services pressure is essential. <strong>Disclosures:</strong> none <strong>Figure 1. </strong>Frequency of service activities during COVID -19 lockdown compared to usual