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Changes in service delivery and access to rheumatologists before and during the COVID-19 pandemic in a Canadian universal healthcare setting

Kwok TSH, Kuriya B, King LK, Eder L, Thorne C, Li Z, Stukel T, Fu L, Kopp A, Widdifield J. J Rheumatol. 2022; Oct 1 [Epub ahead of print]. DOI:

Objective — To describe changes in service delivery and access to rheumatologists pre- and during the COVID-19 pandemic periods.

Methods — We conducted a population-based study in Ontario, Canada. Patient visits with rheumatologists were ascertained using billing claims data. Contacts with rheumatologists were separately defined by the type of patient encounter (including office visits, telemedicine visits, and new patient consultations). Changes in the total weekly volume of encounters and monthly rates after COVID-19 public health measures were imposed were compared to expected baseline rates determined before pandemic onset (March 17, 2020).

Results — In the year prior to the pandemic, there were 289,202 patients (of which 99,641 were new consults) seen by 239 rheumatologists. In the 1 year following the pandemic onset, there were 276,686 patients (of which 88,777 were new consults) seen by 247 rheumatologists. In March 2020, there was an immediate 75.9% decrease in outpatient office visits and a rapid rise in telemedicine visits. By September 2021, 49.7% of patient encounters remained telemedicine visits. For new patient consultations, there was an immediate 50% decrease in visits at the pandemic onset, with 54.8% diverted to telemedicine visits in the first year of the pandemic versus 37.5% by September 2021. New rheumatology consultation rates continued decreasing over the study period.

Conclusion — Rheumatology care delivery has shifted due to the pandemic, with telemedicine sharply increasing early in the pandemic and persisting over time. The pandemic also negatively impacted access to rheumatologists resulting in fewer new consultations, raising concerns for potential delays to diagnosis.