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A review of the latest updates in a post-COVID-19 environment Content developed by Emily Sidlow, Scientific Strategist at Page & Page and Partners on behalf of Pfizer UK, following attendance at the British Society for Rheumatology congress 2022.

Estimated 3 minute read process.

A skilled, empathetic, and actively engaged multidisciplinary team is of upmost importance for optimum quality of life for patients who are dealing with autoimmune rheumatic and musculoskeletal conditions. The complexities presented by these conditions can be numerous and far-reaching and are often accompanied by a significant impact on patients’ quality of life and their ability to work due to the associated pain and loss of function. When focusing on rheumatoid arthritis (RA), the impact on work is clear: it is estimated that work impairment in working patients with RA, including absenteeism and presenteeism, was 45%, with that number increasing to a work disability level of up to 70% after 10 years of disease evolution.^1,2Work disability is a result of multiple factors including disease severity and structural damage, but it is also a psychological and socio-economic issue and is now considered an important outcome in RA.³ Investing in team education is key to improving our understanding of health issues and working to optimise the care that is available for people living with these conditions. Our jobs can play a major role in our lives: it is estimated that up to one third of a person’s life is spent at work. ⁴ To address any inequalities and assess the best possible care provisions, education, in this sense, must reach beyond the patient and their immediate caregivers and healthcare team: it must also reach employers. It is important to shed light on the less obvious costs of these conditions. For some people, work provides an opportunity to maintain their sense of self and purpose, but for others, it can become daunting, painful and, in some cases, impossible. Changes in career progression or employment status due to having a condition can have a major impact on peoples’ lives.

Vocational rehabilitation is the process by which someone who has suffered illness, injury or disability is helped to return to, or to remain in, their professional vocation. This process may draw from a wide range of possible assessments, interventions and services, provided by a range of healthcare professionals.⁵ The WORKWELL trial6 took a biopsychosocial approach to prioritising workplace problems and aimed to identify work barriers and activity limitations to formulate personalised solutions. This involved goal setting and the development of action plans focusing on workstation modifications, assistive technology, equipment changes, work routine or schedule optimisations, transport and exercise advice, and fatigue and stress management assistance. Explanations of employment rights and handling difficult conversations at work to negotiate appropriate modifications to generate a suitable work-life balance are also encouraged.
While the full results are currently pending, it is estimated by Hammond et al. that participants noted the very process of working through barriers and solutions had opened their eyes to exactly what they needed and made the journey to getting there less daunting. Educating wider healthcare teams on these changes and what their patients may be going through outside of their consultations, in addition to the clinical manifestations of their condition, is key to optimising the patient journey. For more information on the WORKWELL trial discussed at BSR 2022, you can visit this link. Please note, this link directs you to a third-party website, owned and operated by an independent party over which Pfizer UK has no control.

Training on these non-clinical adaptations to improve patient care is of upmost importance. The COVID-19 pandemic has understandably had a significant impact on HCPs’ ability to deliver face-to-face care, on the wider healthcare systems’ ability to deliver effective training to their staff, and on trainee wellbeing,⁷ as well as their ability to deliver remote consultations. In a setting where clinical and non-clinical skills are needed to guide patients through their treatment journeys, updating our approaches to upskilling teams and allocating resources within this post-pandemic environment must not be overlooked. Upskilling healthcare teams to deliver effective remote consultations and prescribing with confidence must be prioritised to ensure the patient feels effectively cared for, both clinically and emotionally. The so-called ‘soft skills’ involved in patient care are key to helping patients feel comforted, and to encouraging them to deal with workplace inequalities, and the associated social and economic anxieties that often come with employment challenges. Generic educational programmes offered by the BMJ and MDU can offer support in training for remote consultation scenarios, but they are largely generalised and rarely disease-specific. Ways in which the potentially growing unmet need for training in remote consultation delivery can be addressed are ever changing in line with the post-pandemic world, and healthcare teams must be continuously willing to review their methods of learning, knowledge sharing and care delivery.

The COVID-19 pandemic has imposed challenges to normal approaches to training in both clinical and soft-skill settings, but with this crisis came the necessary and long-needed dissolution of many of the barriers to effective training and education seen in the pre-COVID-19 era.8 While it became clear that virtual training is a useful and often under-utilised tool, it must not be forgotten that the most basic elements of rheumatology and musculoskeletal training and education happen at the bedside, where mastery of examination techniques and medical practices can be measured, discussed, and improved in person. Adapting to this blended learning approach, incorporating in-person and technology-assisted workflows, might perhaps be the key to providing the most effective training and subsequent patient care in the ever-changing post-pandemic world we are living in.