POS1205 THE IMPACT OF COVID-19 ON PATIENT MANAGEMENT AND PRESCRIBING STRATEGY ACROSS THE EU AND US: A REAL-WORLD SURVEY OF RHEUMATOLOGISTS, DERMATOLOGISTS, AND GASTROENTEROLOGISTS
Authors: E. Holdsworth, R. Lukanova, M. Hughes, J. Hall, J. Austin, G. Taylor-Stokes, J. Piercy
Journal: Annals of the Rheumatic Diseases (2021)

Background: The COVID-19 pandemic is expected to have impacted patient management on a global level. However, the degree of impact on patient management and prescribing strategy in the fields of rheumatology, dermatology and gastroenterology is unclear. Objectives: Assess the impact of COVID-19 on patient management and prescribing strategy across the EU and US, as described by rheumatologists, dermatologists, and gastroenterologists. Methods: Data were drawn from physician surveys in France, Germany, Italy, Spain, UK and US between July and December 2020. Physicians completed an online or telephone survey assessing how COVID-19 has impacted type and frequency of consultations; choice and prescription of medication. Results: 847 physicians took part; 355 rheumatologists, 200 dermatologists (Germany, Spain, UK, and US only), and 282 gastroenterologists. As a result of COVID-19, most physicians stated they have moved at least some patients to video or telephone consultations (70% rheumatologists; 55% dermatologists; 60% gastroenterologists) and reduced overall frequency of consultations with patients (59% rheumatologists; 64% dermatologists; 51% gastroenterologists) (Table 1). 35% of rheumatologists, 22% of dermatologists, and 14% of gastroenterologists described COVID-19 as changing the way they choose and prescribe medication, with differences observed between countries (Figure 1). Of those who stated they have made medication changes, rheumatologists stated changing medication to self-administration (62%) and not starting new patients on an advanced therapy (biologic DMARD or targeted synthetic DMARD) (58%) as most frequent. Dermatologists stated changes include changing treatment to more COVID-appropriate treatment (71%) and prescribing repeat prescriptions more regularly without consultation (56%). Gastroenterologists stated changes include changing medication to self-administration (55%) and prescribing a longer course of medication (48%). Comparing across countries, for all specialties, the greatest changes were observed in the UK followed by Spain, with least changes in Germany and Italy. Conclusion: There have been changes in the process of how healthcare is delivered, although treatment prescription was impacted to a lesser extent than consultation type and frequency. This varies across geographies, which may be due to differences in reported prevalence of COVID-19. Differences are also observed across specialities, which may be due to guidance received from specialty bodies. It is unknown what the long-term impact of changes in the management of patients due to COVID-19 will be on patient outcomes, satisfaction, engagement and adherence, and further research is needed. Table 1. Rheumatologist, Dermatologist, and Gastroenterologist described impact on patient management, by country Global (n=847 ) France (n=90 ) Germany (n=168 ) Italy (n=122 ) Spain (n=161 ) UK (n=133 ) US (n=163 ) Rheumatologists n=365 n=50 n=58 n=59 n=57 n=50 n=81 Moving to video/telephone consultation 70% 70% 36% 47% 86% 94% 84% Fewer visits for individual patients (reduced visiting schedule) 59% 80% 0% 41% 96% 76% 65% Dermatologists n=200 - n=50 - n=50 n=50 n=50 Moving to video/telephone consultation 55% - 40% - 58% 66% 56% Fewer visits for individual patients (reduced visiting schedule) 64% - 60% - 54% 72% 72% Gastroenterologists n=282 n=40 n=60 n=63 n=54 n=33 n=32 Moving to video/telephone consultation 60% 63% 18% 54% 83% 100% 69% Fewer visits for individual patients (reduced visiting schedule) 51% 35% 43% 51% 43% 79% 69% Figure 1. Proportion of rheumatologists, dermatologists, and gastroenterologists reporting changing the way they choose and prescribe medication as a result of COVID-19 Disclosure of Interests: None declared.