START TIME 14:40 Assessing the impact of COVID-19 on referrals to musculoskeletal services from primary care and subsequent incidence of inflammatory arthropathies: an observational study of UK national primary care electronic health records

Conference:

SAPC ASM 2022 - UCLan

Talk Code:

2E.4

Presenter:

Claire Burton

Twitter:

@drclaireburton

Co-authors:

Kayleigh Mason, James Bailey, Ram Bajpai, Martin Frisher, Kelvin Jordan, Christian Mallen, Victoria Welsh

Author institutions:

School of Medicine, Keele University, School of Pharmacy and Bioengineering. Keele University

Problem

The early diagnosis and treatment of rheumatoid arthritis (RA) improves long-term outcomes and quality of life. NICE guidance states that adults with suspected persistent synovitis, should be referred to rheumatology services within 3 working days of presenting in primary care. The National Early Inflammatory Arthritis audit observes the percentage of patients referred to rheumatology within 3 days and those seen by a rheumatologist within 3 weeks.

The COVID-19 pandemic meant that the way primary care was delivered changed abruptly. Evidence exists to show cancer referrals and diagnostic delay due to the pandemic have impacted patient outcomes. We have shown that consultations for musculoskeletal problems reduced early in the pandemic and proportionally more patients were prescribed stronger analgesia. We now aim to describe the impact the pandemic has had on time to referral and diagnosis of inflammatory arthropathies (IA), including RA and juvenile inflammatory arthritis (JIA), in patients presenting in primary care with musculoskeletal problems.

Approach

National primary care data from CPRD Aurum was used to describe consultation and referral patterns for patients with musculoskeletal conditions for pre- and peri-pandemic periods. Code lists for musculoskeletal conditions were derived and prevalent and incident consultations determined. For those presenting with musculoskeletal conditions, referrals were matched to consultations. Trends in referrals to musculoskeletal services (including rheumatology and orthopedics) and further incident diagnoses of IA were described using Joinpoint Regression and comparisons made between key time periods (pre/early pandemic, and post-September 2020).

Findings

Our findings to date suggest that incidence of diagnosed IA was stable up to July 2020. The incidence of RA and JIA reduced by -5.17% and -8.26% per month respectively between October 2019 and July 2020. Seasonal drops in incidence had been noted in previous years. It is likely the same winter drop occurred, and was then sustained as the pandemic ensued.

Referral rates to rheumatology, orthopedics and musculoskeletal services, decreased between February 2020 and May 2020 by -18.34% per month in patients presenting with a musculoskeletal condition. After May 2020, referrals did increase significantly (24.42% per month) to July 2020. The period of lower rates of referral coincides with a previously observed increase in the prescription of stronger analgesia.

Consequences

By time of presentation, we will have completed analysis for the next 16 months (August 2020 to October 2021) and compared musculoskeletal consultation, referral and IA incidence rates between key time periods over the pandemic. We will describe any changes in the mode of consultation and discuss how this may impact time between the first musculoskeletal presentation in primary care to referral, and referral to diagnosis of an inflammatory arthropathy. These findings are likely to highlight the importance of being alert to potential new RA diagnoses and referring patients with appropriate urgency.

Submitted by:

Claire Burton

Funding acknowledgement:

Musculoskeletal pain during the COVID-19 pandemic: an observational study of UK national primary care electronic health records is funded by FOREUM (Foundation for Research in Rheumatology). CB and VW are funded by a National Institute for Health Research (NIHR) Clinical Lectureship. KJM, KPJ and CDM are supported by matched funding awarded to the NIHR Applied Research Collaboration (West Midlands). CDM is funded by the NIHR School for Primary Care Research. The views expressed are those of the author(s) and not necessarily those of the (partner organisation), the NHS, the NIHR or the Department of Health and Social Care. The study was approved by the CPRD Independent Scientific Advisory Committee (ref 20_141). This study is based in part on data from the Clinical Practice Research Datalink obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The data is provided by patients and collected by the NHS as part of their care and support. The interpretation and conclusions contained in this study are those of the authors alone.