Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases

• Published in: PloS one 2021-07, Vol.16 (7), p.e0253718-e0253718
• Main Authors: Guaracha-Basáñez, Guillermo A, Contreras-Yáñez, Irazú, Hernández-Molina, Gabriela, González-Marín, Anayanci, Pacheco-Santiago, Lexli D, Valverde-Hernández, Salvador S, Peláez-Ballestas, Ingris, Pascual-Ramos, Virginia
• Format: Article
• Language: English
• Subjects: Bioethics; Biology and Life Sciences; Chronic illnesses; Clinics; Committees; Containment; Coronaviruses; COVID-19; Cross-sectional studies; Disease; Disease control; Ethics; Evaluation; Health care; Health services; Immunology; Immunosuppressive agents; Low income groups; Medical care; Medicine and Health Sciences; Pandemics; Patients; Quality management; Regression analysis; Rheumatic diseases; Rheumatology; Science Policy; Viral diseases; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0253718

To determine the impact of health care interruption (HCI), on clinical status of the patients reincorporated to an outpatient clinic for rheumatic diseases (OCDIR), from a tertiary care level center who was temporally switched to a dedicated COVID-19 hospital, and to provide a bioethical analysis. From March to June 2020, the OCDIR was closed; since June, it is limited to evaluate 25% of the ongoing outpatients. This cross-sectional study surveyed 670 consecutive rheumatic outpatients between June 24.sup.th and October 31.sup.th, concomitant to the assessment of the rheumatic disease clinical status by the attendant rheumatologist, according to disease activity level, clinical deterioration and adequate/inadequate control. Multiple logistic regression analysis identified factors associated to HCI and to clinical deterioration. There were 344 patients (51.3%) with HCI. Non-RA diagnosis (OR: 2.21, 95%CI: 1.5-3.13), comorbidity (OR: 1.7, 95%CI: 1.22-2.37), patient's need for rheumatic care during HCI (OR: 3.2, 95%CI: 2.06-4.97) and adequate control of the rheumatic disease (OR: 0.64, 95%CI: 0.45-0.9) were independently associated to HCI. There were 160 patients (23.8%) with clinical deterioration and associated factors were disease duration, substantial disease activity previous HCI, patients need for rheumatic care and treatment discontinuation. HCI during COVID-19 pandemic impacted course of rheumatic diseases and need to be considered in the bioethical analysis of virus containment measures.