Barriers to Rheumatologic Care and Antimalarial Refills Among a Cohort of Patients with Systemic Lupus Erythematosus During the COVID-19 Pandemic

Background/Purpose: The pandemic of coronavirus disease 19 (COVID-19) has led to widespread disruptions across the spectrum of healthcare We sought to investigate barriers to medical care, including access to ambulatory rheumatology appointments and routine medications such as antimalarials among patients with systemic lupus erythematosus (SLE) in the San Francisco Bay Area using a diverse, population-based cohort Methods: Subjects with SLE in the longitudinal California Lupus Epidemiology Study (CLUES) were administered a structured telephone interview during the COVID-19 pandemic Participants were asked about SLE disease activity, COVID-19 exposures and infection, demographic factors and patient-reported outcomes We collected data on access to ambulatory rheumatology appointments Participants were also asked about difficulties in obtaining timely antimalarial refills since March 2020, encompassing partially filled, delayed or denied refills Using a multivariable logistic regression model, we investigated demographic (age, female sex, nonwhite race) and disease-related factors (Systemic Lupus Activity Questionnaire, or SLAQ) associated with barriers to timely antimalarial refills Results: 202 CLUES cohort members participated in this interview The mean age was 50 (±13 SD), 91% were female, and 64% reported a nonwhite race/ethnicity 89 of 99 (90%) participants who tried to access ambulatory rheumatologic care were able to obtain an appointment;79% of this care was delivered via telephone or video visits Of the 111 participants who attempted to refill their antimalarial since March 2020, 39 (35%) reported partially filled, delayed or denied refills Barriers to timely antimalarial refills were not associated with age, female sex, nonwhite race or SLAQ score Conclusion: These data suggest that in the San Francisco Bay Area, there were minimal disruptions in access to rheumatologic care for people with SLE, which parallels the high rate of virtual care provided during the first months of the pandemic However, participants with SLE did report considerable difficulties in obtaining antimalarial refills This highlights the importance of ensuring an adequate supply and appropriate stewardship of a critical medication for patients with chronic diseases during the COVID-19 pandemic