Objectives We aimed to estimate how rheumatology healthcare use has changed since the COVID-19 pandemic and determine demographic characteristics associated with observed changes in healthcare use.

Methods Using three primary and secondary care electronic health record datasets in England (with the approval of NHS England), Scotland, and Wales, we identified individuals 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), April 2019-November 2023 (England)) and quantified changes using interrupted time-series analysis. We used logistic regression to determine characteristics associated with having fewer appointments compared to 2019.

Results We identified 145,065, 3,813 and 13,637 individuals 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 all other specialist outpatient appointments have recovered in all nations. Ethnic minorities, those living in more deprived areas and urban areas had fewer appointments after the start of the pandemic compared to 2019.

Conclusion For the first time, we compared healthcare use across three UK nations and found that rheumatology outpatient appointments had not recovered to pre-COVID-19 pandemic levels, particularly in Scotland and England. Certain patient groups had fewer appointments during the study period.

Key messages

Rheumatology outpatient appointments remain below pre-pandemic levels, particularly in England and Scotland, unlike other specialties.

Ethnic minorities, deprived communities, and urban residents had fewer rheumatology appointments post-pandemic than in 2019. Rheumatology services need data-driven strategies to provide better support, tailored to local community needs.

BG has received research funding from the Bennett Foundation, the Laura and John Arnold Foundation, the NHS National Institute for Health Research (NIHR), the NIHR School of Primary Care Research, NHS England, the NIHR Oxford Biomedical Research Centre, the Mohn-Westlake Foundation, NIHR Applied Research Collaboration Oxford and Thames Valley, the Wellcome Trust, the Good Thinking Foundation, Health Data Research UK, the Health Foundation, the World Health Organisation, UKRI MRC, Asthma UK, the British Lung Foundation, and the Longitudinal Health and Wellbeing strand of the National Core Studies programme, he is a Non-Executive Director at NHS Digital, he also receives personal income from speaking and writing for lay audiences on the misuse of science. AM is a member of RCGP health informatics group and the NHS Digital GP data Professional Advisory Group, and received consulting fee from Induction Healthcare. LAT has received research funding from MRC, Wellcome, NIHR and GSK, consulted for Bayer in relation to an observational study of chronic kidney disease (unpaid), and is a member of 4 non-industry funded (NIHR/MRC) trial advisory committees (unpaid) and MHRA Expert advisory group (Womens Health). REC has personal shares in AstraZeneca unrelated to this work. RJH has received funding for the present study from the Nuffield Foundation Oliver Bird Fund and has received speaker fees from CSL Vifor. All other authors have no conflicts of interest.

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]. The views expressed are those of the authors and not necessarily those of the NIHR, NHS England, UK Health Security Agency (UKHSA), the Department of Health and Social Care, or other funders. Funders had no role in the study design, collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. 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. LAT is funded by an NIHR Research Professorship NIHR302405.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

In England, this study was approved by the Health Research Authority (REC reference 20/LO/0651) and by the LSHTM Ethics Board (reference 21863). In Wales, the study was approved by the SAIL Information Governance Review Panel (approval number: 0419). Approvals for data linkage in Scotland were obtained from the Public Benefit and Privacy Panel for Health and Social Care, Scotland (reference number 1819-0286).

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