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Management of Rheumatic Diseases During the COVID-19 pandemic: A National Veterans Affairs Survey of Rheumatologists


Arthritis Care Res (Hoboken). 2020 Oct 15;10.1002/acr.24487. doi: 10.1002/acr.24487.Online ahead of print.

Jasvinder A Singh 1 2 3John S Richards 4Elizabeth Chang 5Amy Joseph 6 7Bernard Ng 8 9

Author Information

1 Medicine Service, Birmingham Veterans Affairs (VA) Medical Center, 510, 20th street South, FOT 805B, Birmingham, AL, 35233, USA.

2 Department of Medicine at School of Medicine.

3 Division of Epidemiology at School of Public Health, University of Alabama at Birmingham, 1720 Second Ave South, Birmingham, AL, 35294-0022, USA.

4 VA Pittsburgh Healthcare System, Pittsburgh, PA; Department of Medicine University of Pittsburgh, Pittsburgh, PA, USA.

5 Phoenix VA Medical Center, Phoenix, AZ, USA.

6 VA St. Louis Health Care System.

7 Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.

8 University of Washington, Division of Rheumatology, Seattle, WA, USA.

9 VA Puget Sound Health Care System, Seattle, WA, USA.


Objective: To assess the experience, views and opinions of rheumatology providers at Veterans Affairs (VA) facilities about rheumatic disease healthcare issues during the COVID-19 pandemic.

Methods: We performed an anonymized cross-sectional survey, conducted from April 16 to May 18, 2020, of VA rheumatology providers. We assessed provider perspective on COVID-19 issues and resilience.

Results: Of the 153 eligible VA rheumatologists, 103 (67%) completed the survey. A significant proportion of providers reported ≥50% increase related to COVID-19 in visits by: (1) telephone, 53%; (2) video-based VA video connect (VVC), 44%; and (3) clinical video telehealth (CVT) with a facilitator, 29%. A majority of the responders were somewhat or very comfortable with technology for providing healthcare to established patients during COVID-19 pandemic using: (1) telephone, 87%; (2) VA video connect (VVC), 64%; and (3) in-person visits, 54%. A smaller proportion were comfortable with technology providing healthcare to new patients. At least 65% of rheumatologists considered telephone visits appropriate for established patients with gout, osteoporosis, polymyalgia rheumatica, stable rheumatoid arthritis, stable spondyloarthritis, or osteoarthritis; 32% reported a rheumatology medication shortage. Adjusted for age, sex and ethnicity, high provider resilience was associated with significantly higher odds ratio (OR) of comfort with technology for telephone (OR, 3.1 (95% CI, 1.1-9.7)) and VVC visits for new patients (OR, 4.7 (95% CI, 1.4-15.7)).

Conclusions: A better understanding of COVID-19 rheumatic disease healthcare issues using a health-system approach can better inform providers, improve provider satisfaction and have positive effects on the care of Veterans with rheumatic disease.