Patienthood in the Time of COVID: Using Candidacy to Explore Healthcare Access During a Pandemic

Context: The Covid-19 pandemic and implementation of measures to limit the spread of the virus significantly affected access to healthcare. Routine care in the UK was transformed; remote consultation was introduced for some services while others were disbanded. Public health messaging encouraged the public to stay at home to protect the NHS. Our study investigating the healthcare experience of people living with multimorbidity (presence of ≥2 long term conditions) including Rheumatoid Arthritis (RA) and persistent musculoskeletal (MSK) pain, was suspended because of the pandemic.

Objective: To investigate the experiences of people living with RA or MSK pain during the pandemic.

Study design and analysis: Semi-structured interviews were conducted with 47 people living with RA or persistent MSK pain, with and without multimorbidity. Data were analysed thematically, and findings mapped to the ‘candidacy’ theoretical framework.

Setting and dataset: Participants were recruited from outpatient rheumatology clinics, pain clinics and primary care, in Scotland, UK. Participants were mostly female (31 female, 16 male) and aged between 24 and 92 years.

Results: Our analysis identified themes related to: (1) Healthcare system impacts (remote consultations, delays and cancellations, difficulties accessing care, Covid information) and (2) Impacts on individuals (social and emotional wellbeing, pain and mobility, mental health, care seeking behaviour, employment/finance, understandings of Covid). Themes were mapped to the processes of candidacy. It was clear that the move towards remote consultations may have unintended consequences and should not be ‘one-size fits all’.

Conclusions: Our findings highlight experiences of people with RA/persistent MSK pain and multimorbidity during the Covid-19 pandemic. The health seeking behaviour of some patients has changed, and it is unclear if this will continue in the longer term. These findings support the need for discussion around the longer-term impact of the pandemic on individuals and changes within the healthcare system.