University of British Columbia Vancouver, BC, Canada
Smruthi Ramachandran1, Jenny Leese2, Stephanie Therrien3, Catherine L. Backman1, Jasmin Ma4, Kelly English5, Eileen Davidson6, Shanon McQuitty7, Alison Hoens5, Cheryl Koehn8, James Gavin9, jo Adams9 and Linda Li1, 1University of British Columbia, Vancouver, BC, Canada, 2University of Ottawa, Ottawa, ON, Canada, 3Arthritis Research Canada, Vancouver, BC, Canada, 4Arthritis Research Canada/University of British Columbia, Richmond, BC, Canada, 5Arthritis Patient Advisory Board of Arthritis Research Canada, Vancouver, BC, Canada, 6Arthritis Patient Advisory Board of Arthritis Research Canada, Burnaby, BC, Canada, 7Arthritis Patient Advisory Board of Arthritis Research Canada, Richmond, BC, Canada, 8Arthritis Consumer Experts, Vancouver, BC, Canada, 9University of Southampton, Southampton, United Kingdom
Background/Purpose: The COVID-19 pandemic has provided opportunity to increase integration of virtual healthcare with in-person medical practices. Individuals with rheumatoid arthritis (RA) continue to self-manage their illness while navigating the period of uncertainty in health service delivery systems. Telehealth options for the management of arthritis during the pandemic were uneven, as systems were developed and providers trained to use them. Understanding individuals' experiences will inform the integration of telehealth into routine practice post-pandemic. One aim of our qualitative study was to explore the experiences of individuals with RA accessing telehealth and in-person care.
Methods: The study was jointly designed and conducted with patient partners living with RA. Between December 2020 and December 2021, we conducted one-to-one semi-structured interviews (30-70 mins) with participants with RA. Participants were purposively sampled from an ongoing randomized controlled trial (RCT) testing a web-based self-management intervention. Participants eligible for the RCT had: 1) a physician confirmed diagnosis of RA; 2) no joint surgery in the past 6 months; 3) no history of acute injury to any joints in the past six months; 4) an email address and daily access to a computer or mobile device. In the present qualitative study, we aimed for maximum variation in age, sex, and education, within the limits of RCT sample. A collaborative and reflexive thematic analysis approach was used.
Results: Thirty-nine participants (aged 26-86; 36 females; 13 diagnosed with RA between 2019 - 2021) were interviewed. Approximately two thirds held a university degree or above. Three preliminary themes were identified: 1) Deciding between telehealth and in-person: Many individuals preferred telehealth under certain conditions (e.g., to renew medication, to avoid travelling for appointments). Others favoured in-person consultations for ease of explaining symptoms and signs during a physical assessment; 2) Assessing risk of in-person visits: When in-person consultations were preferred, some feared contracting COVID-19 during or on their way to the consult while others felt safe with the health measures in place; and 3) Adapting to systemic disruptions: Some participants struggled with accessing care as health service delivery changed during the pandemic; patients' in-person appointments were switched to virtual or cancelled without discussion. Others were forced to be flexible given the suspension of in-person clinical care (e.g., receiving a consult outside in the rain).
Conclusion: Our interviews offer nuanced insight into the experiences of individuals with RA seeking health services during the pandemic. People with RA appreciate having a choice between telehealth and in-person consults to best meet their needs, are cautious about accessing health services in-person, and are forced to adjust to obstacles in accessing healthcare. Understanding these perspectives help inform the use of telehealth beyond the pandemic by addressing patient concerns, personalizing telehealth options, and efficiently integrating telehealth into clinical practice for routine check-ups.
Disclosures: S. Ramachandran, None; J. Leese, None; S. Therrien, None; C. Backman, None; J. Ma, None; K. English, None; E. Davidson, None; S. McQuitty, None; A. Hoens, None; C. Koehn, None; J. Gavin, None; j. Adams, None; L. Li, None.
