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

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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270122/
https://www.ncbi.nlm.nih.gov/pubmed/34242245
http://dx.doi.org/10.1371/journal.pone.0253718
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author 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
author_facet 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
author_sort Guaracha-Basáñez, Guillermo A.
collection PubMed
description 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.
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spelling pubmed-82701222021-07-21 Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases 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 PLoS One Research Article 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. Public Library of Science 2021-07-09 /pmc/articles/PMC8270122/ /pubmed/34242245 http://dx.doi.org/10.1371/journal.pone.0253718 Text en © 2021 Guaracha-Basáñez et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
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
Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title_full Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title_fullStr Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title_full_unstemmed Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title_short Clinical and bioethical implications of health care interruption during the COVID-19 pandemic: A cross-sectional study in outpatients with rheumatic diseases
title_sort clinical and bioethical implications of health care interruption during the covid-19 pandemic: a cross-sectional study in outpatients with rheumatic diseases
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8270122/
https://www.ncbi.nlm.nih.gov/pubmed/34242245
http://dx.doi.org/10.1371/journal.pone.0253718
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