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Outpatient hospital attendances in people with rheumatoid arthritis during the COVID-19 pandemic and beyond: a cohort study in three nations of the UK
Ruth E Costello 
,
Michael Parker,
Jonathan Kennedy,
Sinead Brophy ,
Amir Mehrkar,
Sebastian Bacon,
Ben Goldacre ,
Brian MacKenna,
Dave Evans,
Laurie A Tomlinson ,
Rosemary J Hollick ,
Jenny H Humphreys,
(The OpenSAFELY Collective, The RHEUMAPS Study Investigators and the LH&W NCS (or CONVALESCENCE) Collaborative),
Alex J Walker,
Brian MacKenna,
Peter Inglesby,
Ben Goldacre,
Helen J Curtis,
Caroline E Morton,
Jessica Morley,
Amir Mehrkar,
Sebastian C J Bacon,
George Hickman,
Richard Croker,
David Evans,
Tom Ward,
Nicholas J DeVito,
Louis Fisher,
Amelia C A Green,
Jon Massey,
Rebecca M Smith,
William J Hulme,
Simon Davy,
Colm D Andrews,
Lisa E M Hopcroft,
Henry Drysdale,
Iain Dillingham,
Robin Y Park,
Rose Higgins,
Christine Cunningham,
Milan Wiedemann,
Linda Nab,
Steven Maude,
Orla Macdonald,
Ben F C Butler-Cole,
Thomas O'Dwyer,
Catherine L Stables,
Christopher Wood,
Andrew D Brown,
Victoria Speed,
Lucy Bridges,
Andrea L Schaffer,
Caroline E Walters,
Christopher T Rentsch,
Krishnan Bhaskaran,
Anna Schultze,
Elizabeth J Williamson,
Helen I McDonald,
Laurie A Tomlinson,
Rohini Mathur,
Rosalind M Eggo,
Kevin Wing,
Angel Y S Wong,
John Tazare,
Richard Grieve,
Daniel J Grint,
Sinead Langan,
Kathryn E Mansfield,
Ian J Douglas,
Stephen J W Evans,
Liam Smeeth,
Jemma L Walker,
Viyaasan Mahalingasivam,
Harriet Forbes,
Thomas E Cowling,
Emily L Herrett,
Ruth E Costello,
Bang Zheng,
Edward P K Parker,
Christopher Bates,
Jonathan Cockburn,
John Parry,
Frank Hester,
Sam Harper,
Shaun O'Hanlon,
Alex Eavis,
Richard Jarvis,
Dima Avramov,
Paul Griffiths,
Aaron Fowles,
Nasreen Parkes,
Brian Nicholson,
Rafael Perera,
David Harrison,
Kamlesh Khunti,
Jonathan A C Sterne,
Jennifer Quint,
Nishi Chaturvedi,
Chloe Park,
Alisia Carnemolla,
Dylan Williams,
Anika Knueppel,
Andy Boyd,
Emma L Turner,
Katharine M Evans,
Richard Thomas,
Samantha Berman,
Stela McLachlan,
Matthew Crane,
Rebecca Whitehorn,
Jacqui Oakley,
Diane Foster,
Hannah Woodward,
Kirsteen C Campbell,
Nicholas Timpson,
Alex Kwong,
Ana Goncalves Soares,
Gareth Griffith,
Renin Toms,
Louise Jones,
Herbert Annie,
Ruth Mitchell,
Tom Palmer,
Jonathan Sterne,
Venexia Walker,
Lizzie Huntley,
Laura Fox,
Rachel Denholm,
Rochelle Knight,
Kate Northstone,
Arun Kanagaratnam,
Elsie Horne,
Harriet Forbes,
Teri North,
Kurt Taylor,
Marwa A L Arab,
Scott Walker,
Jose I C Coronado,
Arun S Karthikeyan,
George Ploubidis,
Bettina Moltrecht,
Charlotte Booth,
Sam Parsons,
Bozena Wielgoszewska,
Charis Bridger-Staatz,
Claire Steves,
Ellen Thompson,
Paz Garcia,
Nathan Cheetham,
Ruth Bowyer,
Maxim Freydin,
Amy Roberts,
Ben Goldacre,
Alex Walker,
Jess Morley,
William Hulme,
Linda Nab,
Louis Fisher,
Brian MacKenna,
Colm Andrews,
Helen Curtis,
Lisa Hopcroft,
Amelia Green,
Praveetha Patalay,
Jane Maddock,
Kishan Patel,
Jean Stafford,
Wels Jacques,
Kate Tilling,
John Macleod,
Eoin McElroy,
Anoop Shah,
Richard Silverwood,
Spiros Denaxas,
Robin Flaig,
Daniel McCartney,
Archie Campbell,
Laurie Tomlinson,
John Tazare,
Bang Zheng,
Liam Smeeth,
Emily Herrett,
Thomas Cowling,
Kate Mansfield,
Ruth E Costello,
Kevin Wang,
Kathryn Mansfield,
Viyaasan Mahalingasivam,
Ian Douglas,
Sinead Langan,
Sinead Brophy,
Michael Parker,
Jonathan Kennedy,
Rosie McEachan,
John Wright,
Kathryn Willan,
Ellena Badrick,
Gillian Santorelli,
Tiffany Yang,
Bo Hou,
Andrew Steptoe,
Di Gessa Giorgio,
Jingmin Zhu,
Paola Zaninotto,
Angela Wood,
Genevieve Cezard,
Samantha Ip,
Tom Bolton,
Alexia Sampri,
Elena Rafeti,
Fatima Almaghrabi,
Aziz Sheikh,
Syed A Shah,
Vittal Katikireddi,
Richard Shaw,
Olivia Hamilton,
Michael Green,
Theocharis Kromydas,
Daniel Kopasker,
Felix Greaves,
Robert Willans,
Fiona Glen,
Steve Sharp,
Alun Hughes,
Andrew Wong,
Lee Hamill Howes,
Alicja Rapala,
Lidia Nigrelli,
Fintan McArdle,
Chelsea Beckford,
Betty Raman,
Richard Dobson,
Amos Folarin,
Callum Stewart,
Yatharth Ranjan,
Jd Carpentieri,
Laura Sheard,
Chao Fang,
Sarah Baz,
Andy Gibson,
John Kellas,
Stefan Neubauer,
Stefan Piechnik,
Elena Lukaschuk,
Laura C Saunders,
James M Wild,
Stephen Smith,
Peter Jezzard,
Elizabeth Tunnicliffe,
Zeena-Britt Sanders,
Lucy Finnigan,
Vanessa Ferreira,
Mark Green,
Rebecca Rhead,
Milla Kibble,
Yinghui Wei,
Agnieszka Lemanska,
Francisco Perez-Reche,
Dominik Piehlmaier,
Lucy Teece,
Edward Parker,
Rosemary J Hollick,
Corri Black,
Sinead Brophy,
Ernest Choy,
Gary Macfarlane,
Louise Bennett,
Lorna Philip,
Michelle Stevenson,
Denise McFarlane,
Laura Moir,
Ian Allotay,
Philip Bell,
Amanda Cheesley,
Charlotte Marlow,
Farzana Kausir,
Emily Lam,
Inga Wood,
Michael Parker,
Jonathan Kennedy
,
Michael Parker,
Jonathan Kennedy,
Sinead Brophy ,
Amir Mehrkar,
Sebastian Bacon,
Ben Goldacre ,
Brian MacKenna,
Dave Evans,
Laurie A Tomlinson ,
Rosemary J Hollick ,
Jenny H Humphreys,
(The OpenSAFELY Collective, The RHEUMAPS Study Investigators and the LH&W NCS (or CONVALESCENCE) Collaborative),
Alex J Walker,
Brian MacKenna,
Peter Inglesby,
Ben Goldacre,
Helen J Curtis,
Caroline E Morton,
Jessica Morley,
Amir Mehrkar,
Sebastian C J Bacon,
George Hickman,
Richard Croker,
David Evans,
Tom Ward,
Nicholas J DeVito,
Louis Fisher,
Amelia C A Green,
Jon Massey,
Rebecca M Smith,
William J Hulme,
Simon Davy,
Colm D Andrews,
Lisa E M Hopcroft,
Henry Drysdale,
Iain Dillingham,
Robin Y Park,
Rose Higgins,
Christine Cunningham,
Milan Wiedemann,
Linda Nab,
Steven Maude,
Orla Macdonald,
Ben F C Butler-Cole,
Thomas O'Dwyer,
Catherine L Stables,
Christopher Wood,
Andrew D Brown,
Victoria Speed,
Lucy Bridges,
Andrea L Schaffer,
Caroline E Walters,
Christopher T Rentsch,
Krishnan Bhaskaran,
Anna Schultze,
Elizabeth J Williamson,
Helen I McDonald,
Laurie A Tomlinson,
Rohini Mathur,
Rosalind M Eggo,
Kevin Wing,
Angel Y S Wong,
John Tazare,
Richard Grieve,
Daniel J Grint,
Sinead Langan,
Kathryn E Mansfield,
Ian J Douglas,
Stephen J W Evans,
Liam Smeeth,
Jemma L Walker,
Viyaasan Mahalingasivam,
Harriet Forbes,
Thomas E Cowling,
Emily L Herrett,
Ruth E Costello,
Bang Zheng,
Edward P K Parker,
Christopher Bates,
Jonathan Cockburn,
John Parry,
Frank Hester,
Sam Harper,
Shaun O'Hanlon,
Alex Eavis,
Richard Jarvis,
Dima Avramov,
Paul Griffiths,
Aaron Fowles,
Nasreen Parkes,
Brian Nicholson,
Rafael Perera,
David Harrison,
Kamlesh Khunti,
Jonathan A C Sterne,
Jennifer Quint,
Nishi Chaturvedi,
Chloe Park,
Alisia Carnemolla,
Dylan Williams,
Anika Knueppel,
Andy Boyd,
Emma L Turner,
Katharine M Evans,
Richard Thomas,
Samantha Berman,
Stela McLachlan,
Matthew Crane,
Rebecca Whitehorn,
Jacqui Oakley,
Diane Foster,
Hannah Woodward,
Kirsteen C Campbell,
Nicholas Timpson,
Alex Kwong,
Ana Goncalves Soares,
Gareth Griffith,
Renin Toms,
Louise Jones,
Herbert Annie,
Ruth Mitchell,
Tom Palmer,
Jonathan Sterne,
Venexia Walker,
Lizzie Huntley,
Laura Fox,
Rachel Denholm,
Rochelle Knight,
Kate Northstone,
Arun Kanagaratnam,
Elsie Horne,
Harriet Forbes,
Teri North,
Kurt Taylor,
Marwa A L Arab,
Scott Walker,
Jose I C Coronado,
Arun S Karthikeyan,
George Ploubidis,
Bettina Moltrecht,
Charlotte Booth,
Sam Parsons,
Bozena Wielgoszewska,
Charis Bridger-Staatz,
Claire Steves,
Ellen Thompson,
Paz Garcia,
Nathan Cheetham,
Ruth Bowyer,
Maxim Freydin,
Amy Roberts,
Ben Goldacre,
Alex Walker,
Jess Morley,
William Hulme,
Linda Nab,
Louis Fisher,
Brian MacKenna,
Colm Andrews,
Helen Curtis,
Lisa Hopcroft,
Amelia Green,
Praveetha Patalay,
Jane Maddock,
Kishan Patel,
Jean Stafford,
Wels Jacques,
Kate Tilling,
John Macleod,
Eoin McElroy,
Anoop Shah,
Richard Silverwood,
Spiros Denaxas,
Robin Flaig,
Daniel McCartney,
Archie Campbell,
Laurie Tomlinson,
John Tazare,
Bang Zheng,
Liam Smeeth,
Emily Herrett,
Thomas Cowling,
Kate Mansfield,
Ruth E Costello,
Kevin Wang,
Kathryn Mansfield,
Viyaasan Mahalingasivam,
Ian Douglas,
Sinead Langan,
Sinead Brophy,
Michael Parker,
Jonathan Kennedy,
Rosie McEachan,
John Wright,
Kathryn Willan,
Ellena Badrick,
Gillian Santorelli,
Tiffany Yang,
Bo Hou,
Andrew Steptoe,
Di Gessa Giorgio,
Jingmin Zhu,
Paola Zaninotto,
Angela Wood,
Genevieve Cezard,
Samantha Ip,
Tom Bolton,
Alexia Sampri,
Elena Rafeti,
Fatima Almaghrabi,
Aziz Sheikh,
Syed A Shah,
Vittal Katikireddi,
Richard Shaw,
Olivia Hamilton,
Michael Green,
Theocharis Kromydas,
Daniel Kopasker,
Felix Greaves,
Robert Willans,
Fiona Glen,
Steve Sharp,
Alun Hughes,
Andrew Wong,
Lee Hamill Howes,
Alicja Rapala,
Lidia Nigrelli,
Fintan McArdle,
Chelsea Beckford,
Betty Raman,
Richard Dobson,
Amos Folarin,
Callum Stewart,
Yatharth Ranjan,
Jd Carpentieri,
Laura Sheard,
Chao Fang,
Sarah Baz,
Andy Gibson,
John Kellas,
Stefan Neubauer,
Stefan Piechnik,
Elena Lukaschuk,
Laura C Saunders,
James M Wild,
Stephen Smith,
Peter Jezzard,
Elizabeth Tunnicliffe,
Zeena-Britt Sanders,
Lucy Finnigan,
Vanessa Ferreira,
Mark Green,
Rebecca Rhead,
Milla Kibble,
Yinghui Wei,
Agnieszka Lemanska,
Francisco Perez-Reche,
Dominik Piehlmaier,
Lucy Teece,
Edward Parker,
Rosemary J Hollick,
Corri Black,
Sinead Brophy,
Ernest Choy,
Gary Macfarlane,
Louise Bennett,
Lorna Philip,
Michelle Stevenson,
Denise McFarlane,
Laura Moir,
Ian Allotay,
Philip Bell,
Amanda Cheesley,
Charlotte Marlow,
Farzana Kausir,
Emily Lam,
Inga Wood,
Michael Parker,
Jonathan Kennedy
Rheumatology, Volume: 65, Issue: 1, Start page: keaf559
Swansea University Authors:
Sinead Brophy , Michael Parker, Jonathan Kennedy
-
PDF | Version of Record
©The Author(s) 2025. This is an Open Access article distributed under the terms of the Creative Commons Attribution License.
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DOI (Published version): 10.1093/rheumatology/keaf559
Abstract
Objectives: We aimed to estimate how rheumatology outpatient hospital attendances have changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes. Methods: Using three primary and secondary care electronic health record datasets in England (with th...
| Published in: | Rheumatology |
|---|---|
| ISSN: | 1462-0324 1462-0332 |
| Published: |
Oxford University Press (OUP)
2026
|
| Online Access: |
Check full text
|
| URI: | https://cronfa.swan.ac.uk/Record/cronfa70816 |
| Abstract: |
Objectives: We aimed to estimate how rheumatology outpatient hospital attendances have changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes. Methods: Using three primary and secondary care electronic health record datasets in England (with the approval of NHS England), Scotland, and Wales, we identified people with a diagnosis of rheumatoid arthritis (RA) before 01/04/2019. We determined the proportion of people with rheumatology hospital outpatient appointments each month (April 2019-December 2022 (Wales and Scotland), November 2023 (England)) and quantified changes using interrupted time-series analysis. We used logistic regression to determine characteristics associated with having fewer appointments compared with 2019. Results: We identified 145 065, 3,813 and 13 637 people coded with RA in England, Scotland, and Wales, respectively. At the start of the COVID-19 pandemic the number of rheumatology outpatient appointments dropped sharply across all nations. In England and Scotland, the percentage of monthly appointments has continued to decline. In Wales, while there was a gradual recovery, rheumatology services have not returned to pre-pandemic levels. In contrast, the number of appointments for other specialties has recovered in all nations. People with no rheumatology outpatient appointments were more often aged over 80, male, and living in rural areas. Ethnic minorities, those living in more deprived, and urban areas had fewer appointments after the start of the pandemic compared with 2019. Conclusion: For the first time, we compared healthcare use across three UK nations and found rheumatology outpatient appointments had not recovered to pre-COVID-19 pandemic levels, particularly in Scotland and England. |
|---|---|
| Keywords: |
Rheumatoid Arthritis, delivery of health care, inequalities, observational studies, organisation of health care |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
In England, the OpenSAFELY platform is principally funded by grants from:
• NHS England [2023-2025];
• The Wellcome Trust (222097/Z/20/Z) [2020-2024];
• MRC (MR/V015737/1) [2020-2021].
Additional contributions to OpenSAFELY have been funded by grants from:
• MRC via the National Core Study programme, Longitudinal Health and Wellbeing strand (MC_PC_20030, MC_PC_20059) [2020-2022] and the Data and Connectivity strand (MC_PC_20058) [2021-2022];
• NIHR and MRC via the CONVALESCENCE programme (COV-LT-0009, MC_PC_20051) [2021-2024];
• NHS England via the Primary Care Medicines Analytics Unit [2021-2024].
Funding for the RHEUMAPS study and creation and analysis of the Scotland and Wales
datasets used in this study was provided by the Nuffield Foundation Oliver Bird Fund (grant
number OBF/44000). |
| Issue: |
1 |
| Start Page: |
keaf559 |