Effect of the COVID-19 pandemic on outpatient care and rehabilitation in neuromuscular clinical practice in Japan: a health insurance claims database analysis

• Published in: BMJ open 2023-06, Vol.13 (6), p.e070818-e070818
• Main Authors: Saito, Toshio, Matsuo-Tezuka, Yukari, Sugitani, Yasuo, Tajima, Takumi, Fukao-Washino, Junko, Sakai, Sadaoki, Iwagami, Masao
• Format: Article
• Language: English
• Subjects: Ambulatory Care; Autoimmune diseases; Clinical medicine; COVID-19; COVID-19 - epidemiology; Encephalitis; epidemiology; Guillain-Barre syndrome; Health care; Health insurance; Humans; Hypothesis testing; Insurance claims; Insurance, Health; Japan - epidemiology; Muscular Atrophy, Spinal; Myasthenia gravis; Neurology; neuromuscular disease; Neuromuscular diseases; Pandemics; Patients; Population density; Rehabilitation; Retrospective Studies; Urban areas
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2022-070818

ObjectivesTo evaluate the impact of the COVID-19 pandemic on outpatient care in Japanese patients with neuromuscular diseases (NMDs).DesignThis retrospective cohort study included patients between January 2018 and February 2019; the follow-up period was divided into ‘before COVID-19’ (March 2019–February 2020) and ‘during COVID-19’ (March 2020–February 2021).SettingJMDC claims database study.ParticipantsOf the 10 655 557 patients identified, we included patients with spinal muscular atrophy (SMA; n=82), neuromyelitis optica (NMO; n=342), myasthenia gravis (MG; n=1347), Guillain-Barré syndrome (GBS; n=442) or autoimmune encephalitis/encephalopathy (AIE; n=133). Patients were required to have ≥1 month of data available, have a diagnosis of NMD during the enrolment period and be available for follow-up.Primary and secondary outcome measuresWe estimated the proportion of patients with >30% change in outpatient consultation and rehabilitation visits before versus during the COVID-19 pandemic.ResultsSmall reductions in the proportion of patients with outpatient consultation/rehabilitation visits were observed before versus during the pandemic. Compared with before the pandemic, 30.4%, 27.8%, 28.7%, 49.4% and 50.0% of patients showed a >30% decrease in outpatient consultation visits and 58.6%, 75.0%, 50.0%, 76.3% and 84.6% showed a >30% decrease in outpatient rehabilitation visits during the pandemic for SMA, NMO, MG, GBS and AIE, respectively. The median change in the number of outpatient consultation visits per year before versus during pandemic was −1.0 day for all NMDs, and that in outpatient rehabilitation visits per year was −6.0, –5.5, −1.5, –6.5 and −9.0 days for SMA, NMO, MG, GBS and AIE, respectively. The reduction in outpatient rehabilitation visits was greater in the absence versus presence of a neurology specialist.ConclusionsOutpatient consultation and rehabilitation visits during the COVID-19 pandemic were affected in Japanese patients with NMDs. Longer-term evaluations are required to understand if these reductions in outpatient care would affect patient prognosis.