Post-COVID-19 assessment in a specialist clinical service: a 12-month, single-centre, prospective study in 1325 individuals

Abstract

IntroductionPost-COVID-19 complications require simultaneous characterisation and management to plan policy and health system responses. We describe the 12-month experience of the first UK dedicated post-COVID-19 clinical service to include hospitalised and non-hospitalised patients.MethodsIn a single-centre, observational analysis, we report the demographics, symptoms, comorbidities, investigations, treatments, functional recovery, specialist referral and rehabilitation of 1325 individuals assessed at the University College London Hospitals post-COVID-19 service between April 2020 and April 2021, comparing by referral route: posthospitalised (PH), non-hospitalised (NH) and post emergency department (PED). Symptoms associated with poor recovery or inability to return to work full time were assessed using multivariable logistic regression.Results1325 individuals were assessed (PH: 547, 41.3%; PED: 212, 16%; NH: 566, 42.7%). Compared with the PH and PED groups, the NH group were younger (median 44.6 (35.6–52.8) years vs 58.3 (47.0–67.7) years and 48.5 (39.4–55.7) years), more likely to be female (68.2%, 43.0% and 59.9%), less likely to be of ethnic minority (30.9%, 52.7% and 41.0%) or seen later after symptom onset (median (IQR): 194 (118–298) days, 69 (51–111) days and 76 (55–128) days; all p<0.0001). All groups had similar rates of onward specialist referral (NH 18.7%, PH 16.1% and PED 18.9%, p=0.452) and were more likely to require support for breathlessness (23.7%, 5.5% and 15.1%, p<0.001) and fatigue (17.8%, 4.8% and 8.0%, p<0.001). Hospitalised patients had higher rates of pulmonary emboli, persistent lung interstitial abnormalities and other organ impairment. 716 (54.0%) individuals reported <75% optimal health (median 70%, IQR 55%–85%). Less than half of employed individuals could return to work full time at first assessment.ConclusionPost-COVID-19 symptoms were significant in PH and NH patients, with significant ongoing healthcare needs and utilisation. Trials of interventions and patient-centred pathways for diagnostic and treatment approaches are urgently required.

A survey of dedicated PASC clinics: Characteristics, barriers and spirit of collaboration

“…Similar to the current study, all clinical models described previously include the involvement of multiple specialties. [12][13][14][15][16][17][18] The current study demonstrates a mix of clinics that routinely have multiple providers see patients at the initial visits and clinics that had the initial visit consist of one provider with established processes to see other specialties. Previous clinical models also varied between having multiple specialties involved in the initial visit [14][15][16] and using "a hub and spoke model" with a core clinician and directed referrals or sequential visits from multiple specialists.…”

“…Although several articles describe PASC clinics and make recommendations on how to organize them, there is very little evidence to support one clinical model over another. [12][13][14][15][16][17][18] One of the first steps in understanding and developing a clinical standard of care is gaining a better understanding of current practices. The current survey results cannot demonstrate the effectiveness of one care model over another; however, it does suggest areas that are widely shared between PASC clinics and areas in which there are substantial differences in practice.…”

“…Previous clinical models also varied between having multiple specialties involved in the initial visit [14][15][16] and using "a hub and spoke model" with a core clinician and directed referrals or sequential visits from multiple specialists. 12,13,[16][17][18] About half of clinics have interdisciplinary team meetings in the current study. This contrasts with almost all previously published clinical models that recommend a multi-disciplinary care team meeting or case review.…”

“…This contrasts with almost all previously published clinical models that recommend a multi-disciplinary care team meeting or case review. [12][13][14][16][17][18] Telehealth was used frequently for assessment in the current study as well as previously described care models. 14,[16][17][18] Finally, although most clinics use standardized assessments/outcome measures in the current study, similar to previously described models, the specific choices of tests vary widely.…”

“…14,[16][17][18] Finally, although most clinics use standardized assessments/outcome measures in the current study, similar to previously described models, the specific choices of tests vary widely. [12][13][14][15]17,18 Despite the fact that many areas lack consensus, there are lessons that may be of benefit to developing PASC clinics. Practices that the majority of established PASC clinics use may suggest efficacy and serve as a starting point.…”