Differences in Patient and Physician Perceptions of Urgency for Musculoskeletal Conditions During the COVID-19 Pandemic

The Perspective of Patients and Health Professionals on the Prioritization of Assisted Reproductive Techniques. The PRIOFER Study

Purpose

To determine the perspective of patients and professionals in Assisted Reproduction Units (ARU) on the importance of assisted reproductive techniques (ART) compared to other elective procedures, to highlight the relevance of ART as an elective procedure and the impact of delayed interventions on patients.

Design Patients and Methods

An observational, descriptive, cross-sectional, online survey-based study was conducted in infertility patients and partners (n=98) and ARU healthcare professionals (n=83). The survey included a best-worst scaling (BWS) experiment and an ad-hoc questionnaire to analyze the pandemic impact on ART management and infertility patients in Spain. In the BWS, each respondent established priorities choosing which patient profile should be rated as the highest and lowest priority profile on a waiting list. To understand the importance that they give to assisted reproduction compared to other procedures, three very common elective procedures involving different patient profiles were selected: cataract surgery, knee arthroplasty, and varicose vein surgery. For each procedure, three hypothetical patient profiles corresponding to three different degrees of severity on a waiting list were designed.

Results

Patients attributed greater importance to ART profiles (BWS score: patients 0.14 vs professionals -0.05; p<0.01) whereas professionals prioritized cataract surgery (patients 0.06 vs professionals 0.23; p<0.01). Concerning the profile severity, more severe profiles were prioritized in all procedures by both groups. Patients' and professionals' perspectives on the impact of the pandemic were similar, with exceptions: information received for resuming ART; health care provision in crisis situations; and reduction of parenting options. The pandemic affected patients' ability to conceive a child (70.4% of those surveyed), their psychological well-being (75.5%), and partner, social, and work relationships (69.4%).

Conclusion

Preference studies involving patients and professionals can provide important information to define framework criteria for the management of waiting lists for elective procedures, and to prioritize interventions during pandemic periods. The pandemic impact on infertility patients highlights the relevance of developing measures and strategies to cope with similar future situations in the most appropriate way.

Unit Sales Trends of Hip Arthroplasty Procedures Performed in Ontario in 2020

BACKGROUND

In March 2020, an emergency was declared in the province of Ontario owing to the COVID-19 pandemic. From March 19 to May 26, all elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures were deferred. The purpose of this study was to review the unit sales data of THA and TKA procedures in Ontario over this time period to identify any trends in surgical activity.

METHODS

Unit sales data for all THA and TKA procedures performed in Ontario between January 2019 and December 2020 were reviewed. All orthopedic companies contributed to the data set. Femoral stems were considered an indicator of THA procedures, while primary femurs were considered an indicator of TKA procedures. Data were analyzed to determine trends in THA and TKA procedures during the deferral period and the relative change in THA and TKA activity following resumption.

RESULTS

There was a 53% reduction in THA activity between March and May of 2020 when compared to the same interval in 2019. From June to September of 2019, THA sales activity was 87.3% that of TKA. From June to September of 2020, THA sales activity was 122.8% that of TKA.

CONCLUSION

Provincial directives aimed at controlling the outbreak of COVID-19 contributed to a substantial reduction in THA and TKA activity in 2020. Compared to 2019, there was a disproportionate increase in THA compared to TKA activity in 2020 following resumption of surgical services. These data have implications in recovery planning for the surgical backlog of THA in Ontario.