Lessons from experiences of accessing healthcare during the pandemic for remobilising rheumatology services: a national mixed methods study

Lakrista Morton, Kevin Stelfox, Marcus Beasley, Gareth Jones, Gary Macfarlane, Peter Murchie, William John Paton, Rosemary Hollick* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Objectives: To understand the impact of the COVID-19 pandemic on access to healthcare services for patients with inflammatory and non-inflammatory MSK conditions.
Methods: Three established cohorts which included individuals with axial spondyloarthritis, psoriatic arthritis, and musculoskeletal pain completed a questionnaire between July and December 2020. In parallel, a subset of individuals participated in semi-structured interviews.
Results: 1054 people (45% female, median age 59 years) were included in the quantitative analyses.
Qualitative data included 447 free-text questionnaire responses and 23 interviews. 57% respondents had tried to access care since the start of UK national lockdown. Over a quarter reported being unable to book any type of healthcare appointment. GP appointments were less likely to be delayed
or cancelled compared to hospital appointments. Younger age, unemployment/health-related retirement, DMARD therapy, anxiety or depression and being extremely clinically vulnerable was associated with a greater likelihood of attempting to access healthcare. People not in work, those
reporting anxiety or depression and poorer quality of life were less likely to be satisfied with remotely-delivered healthcare. Participants valued clear, timely and transparent care pathways across primary care and specialist services. Whilst remote consultations were convenient for some, in-person appointments enabled physical assessment and facilitated development and maintenance
of clinical relationships with care providers.
Conclusions: We have identified patient factors that predict access to and satisfaction with care, and aspects of care that patients value. This is important to inform remobilisation of rheumatology services to better meet the needs of patients.
Original languageEnglish
Article numberrkac013
Number of pages15
JournalRheumatology Advances in Practice
Issue number1
Early online date16 Feb 2022
Publication statusPublished - 23 Mar 2022

Bibliographical note

We are grateful to our patient partner Inga Wood for help with designing the interview schedule and for commenting on the manuscript and Lynne Laidlaw for help with designing the questionnaire. The authors do not report any conflicts of interest. GJM conceived the idea for the study and all authors were involved in the detailed planning. LM, KS, and RH conducted the qualitative analysis with input from JP. MB and GJ undertook the questionnaire analysis. LM and RH integrated quantitative and qualitative findings, and KS, JP and GJM contributed to interpretation of findings. RH and LM drafted the manuscript and all authors contributed important intellectual content via written comments.
This work was supported by Versus Arthritis [Grant No: 20748] and the British Society for Rheumatology. The funding for the original studies included were from Versus Arthritis (MAmMOTH) and the British Society for Rheumatology (BSRBR-AS and BSR-PsA). LM is supported by the MRC/Versus Arthritis Centre for Musculoskeletal Health and Work [Grant No: 20665].

Data Availability Statement

The data within the article that relate to the collection of BSR register data are owned by the BSR. Access to these data are subject to application being made to the BSR Registers (https://rheumatology.org.uk). For other quantitative data in the article, application can be made for access by contacting the corresponding author.


  • COVID-19
  • axial spondyloarthritis
  • psoriatic arthritis
  • pain
  • healthcare access
  • healthcare behaviour


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