Open AccessClinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
Author(s) -
Guillermo Guaracha-Basáñez,
Irazú Contreras-Yáñez,
Gabriela Hernández-Molina,
Anayanci González-Marín,
Lexli D. Pacheco-Santiago,
Salvador Saúl Valverde-Hernández,
Ingris PeláezBallestas,
Virginia PascualRamos
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0253718
Subject(s) - medicine , comorbidity , cross sectional study , pandemic , disease , outpatient clinic , health care , logistic regression , rheumatology , physical therapy , pediatrics , covid-19 , infectious disease (medical specialty) , pathology , economics , economic growth
Background 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. Methods 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 th and October 31 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. Results Patients were middle-aged females (86.7%), with median disease duration of 10 years, comorbidity (38.5%) and 138 patients (20.6%) had discontinued treatment. Primary diagnoses were SLE and RA, in 285 (42.5%) and 223 (33.3%) patients, respectively. 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. Conclusions HCI during COVID-19 pandemic impacted course of rheumatic diseases and need to be considered in the bioethical analysis of virus containment measures.