Disruptions in Rheumatology Care and the Rise of Telehealth in Response to the COVID19 Pandemic in a Community Practice-Based Network.

BACKGROUND: The effect of the COVID19 pandemic on community-based rheumatology care and use of telehealth is unclear. METHODS: Using a community practice-based rheumatologist network, we examined trends in in-person vs. telehealth visits vs. canceled visits in three time periods: pre-COVID19, COVID19-Transition (6-weeks beginning 3/23/20), and post-COVID19-Transition (May-August). In the Transition period, we compared patients who received in-person care vs. telehealth visits vs. cancelled all visits. We used multivariable logistic regression to identify factors associated with canceled or telehealth visits. RESULTS: Pre-COVID19, there were 7,075 visits/week among 60,002 unique rheumatology patients cared for by approximately 300 providers practicing in 92 offices. This decreased substantially (24.6% reduction) during COVID19-Transition period for in-person but rebounded to pre-COVID19 levels during post-COVID19 transition. There were almost no telehealth visits pre-COVID19, but telehealth increased substantially during the COVID19-Transition (41.4% of all follow-up visits) and slightly decreased during post-COVID19-Transition (27.7% of visits). Older age, female sex, Black or Hispanic race/ethnicity, lower socioeconomic status, and rural residence were associated with greater likelihood of cancelling visits. Most factors were also associated with a lower likelihood of having telehealth vs. in-office visits. Patients living further from the rheumatologists' office were more likely to use telehealth. CONCLUSION: COVID19 led to large disruptions in rheumatology care; these disruptions were only partially offset by increases in telehealth use and disproportionately affected racial/ethnic minorities and patients with lower socioeconomic status. During the COVID-19 era, telehealth continues to be an important part of rheumatology practice, but disparities in access to care exist for some vulnerable groups.