Post-COVID assessment in a specialist clinical service: a 12-month, single-centre analysis of symptoms and healthcare needs in 1325 individuals

Heightman, Melissa; Prashar, Jai; Marks, Michael; Livingston, Rebecca; Ridsdale, Heidi A; Roy, Kay; Bell, Robert M.; Zandi, Michael S; McNamara, Patricia; Chauhan, Alisha; Denneny, Emma; Astin, Rónan; Purcell, H; Attree, Emily; Hishmeh, Lyth; Prescott, Gordon; Evans, R.; Mehta, Puja; Brennan, Ewen; Brown, Jeremy; Porter, Joanna C.; Logan, Sarah; Wall, Emma C; Dehbi, Hakim‐Moulay; Cone, Stephen; Banerjee, Amitava

doi:10.1101/2021.05.25.21257730

Cited by 10 publications

(10 citation statements)

References 22 publications

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“… 7 Reported fatigue has ranged markedly in the studies to date, with a higher proportion fatigued in the non-hospitalised population than those hospitalised. 3 Mandal et al 8 noted fatigue in 69% of patients at 378 days, and Huang et al 9 identified 63% with self-reported fatigue or muscle weakness at 153 days post-discharge; however, our data, in a non-hospitalised population, is lower than this. In a non-hospitalised population, Petersen et al 10 reported a similar incidence to the current study (<30%) 4 months following acute illness.…”

Section: Discussioncontrasting

confidence: 72%

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Patient-related outcomes in patients referred to a respiratory clinic with persisting symptoms following non-hospitalised COVID-19

et al. 2022

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Survivors of COVID-19 can present with varied and persisting symptoms, regardless of hospitalisation. We describe the ongoing symptoms, quality of life and return to work status in a cohort of non-hospitalised COVID-19 survivors with persisting respiratory symptoms presenting to clinic, who consented and completed patient-reported outcome measures. We identified fatigue, reduced quality of life and dysregulated breathing alongside the breathlessness. Those with co-existent fatigue had worse mood and quality of life and were less likely to have returned to normal working arrangements compared to those without fatigue. For non-hospitalised people with persisting symptoms following COVID-19 referred to a respiratory assessment clinic, there was a need for a wider holistic assessment, including return to work strategies.

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Section: Discussioncontrasting

confidence: 72%

“…This demonstrates a wider physical and psychosocial impact beyond the acute illness phase. 1 Recent studies of hospitalised and non-hospitalised cohorts 1,3 identified a number of symptoms and post-COVID phenotypes spanning mental and physical health.…”

Section: Introductionmentioning

confidence: 99%

Patient-related outcomes in patients referred to a respiratory clinic with persisting symptoms following non-hospitalised COVID-19

et al. 2022

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“…We identified 2184 citations, screened 1806 titles and abstract, 65 full text and included 12 articles reporting on care models for Long COVID (Figure 1) [10][11][12][13][14][15][16][17][18][19][20][21] .…”

Section: Literature Searchmentioning

confidence: 99%

Care Models for Long COVID : A Rapid Systematic Review

Décary

Dugas²,

Stefan³

et al. 2021

Preprint

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ContextMore than 18M people worldwide (150K Canadians) are living with Long COVID resulting in debilitating sequalae and disabilities that impact their quality of life and capacity to return to work. A new care model is needed for persons living with this complex and multi-systemic disease.ObjectivesWhat is the best-available evidence about care models for persons living with Long COVID?DesignRapid Living Systematic Review.MethodWe systematically searched seven electronic databases (MEDLINE, Embase, Web of Science, COVID-END, L-OVE, CDRS and WHO Ovid) on May 27th, 2021. Two independent reviewers screened titles, abstracts and full text. We included studies reporting on 1- persons living with Long COVID and 2- proposing a specific care model (i.e., dedicated clinic, care pathway). We extracted characteristic of studies (e.g., countries, study design, age group), referral pathways targeted (e.g., hospitalized, community), reporting of the care model implementation with number of patients, clinical settings of care model (e.g., primary care), healthcare professions included in the care model, care model principles (e.g., person-centred care) and care model components (e.g., standardized symptoms assessment). We used descriptive statistics and frequency count.ResultsWe screened 2181 citations, read 65 full text and included 12 eligible articles reporting on care models for Long COVID. Half studies were from the United Kingdom. 7 out of 12 models reported conceptual models without a description of implementation. All but one model was designed for discharge and long-term follow-up of hospitalized patients and half models were designed for non- hospitalized or patients who lived with the disease only in the community. Nine out of 12 care models included primary care, 8 out of 12 included specialized clinics and all studies included rehabilitation services. A total of 30 healthcare professions and medical specialties were proposed for staffing Long COVID services. More than half studies proposed multidisciplinary teams, integrated/coordination of care, evidence-based care and patient-centred care as key care model principles. Standardized symptom assessment, follow-up system and virtual care were the most frequent care model components.ConclusionThe implementation of care models for Long COVID is underway in several countries. Care models need to include both hospitalized and non-hospitalized patients. A complete care model for this population appears to design a care pathway integrating primary care, rehabilitation services and specialized clinics for medical assessment. The entry into care pathways is likely possible through a centralized referral system. It is possible to design sustainable and equitable care pathways for Long COVID in Canada integrated in current infrastructure.Protocol/Topic RegistrationCRD42021282266SummaryAn estimated 150K Canadians, mostly women, are facing debilitating sequalae and disabilities from Long COVID that impact their quality of life and capacity to return to work. A new care model is needed for persons with this complex and multi-systemic disease. We identified international care models describing the integration of primary care, rehabilitation services and specialized assessment clinics for Long COVID.ImplicationsLimited evidence from this review of international care models for Long COVID point out to a care model for the Canadian context that should be co- designed with patients, clinicians, decision makers and researchers, and include: 1- A coordination unit to centrally receive referrals from both hospitalized and community-based patients; 2- Training of primary care teams to screen and support medical needs; 3- Integrated local multidisciplinary rehabilitation services; and 4- Access to medical specialty clinics for advanced testing and diagnoses.What is the current situation?More than 150K Canadians are with living the affliction of Long COVID, the patient-led term to describe long-term consequences of COVID-19. Long COVID is a multi-systemic and unpredictable disease impacting quality of life and return to work in middle aged population. To avoid widespread long-term disabilities impacting public health, Canadian provinces are seeking to organize a sustainable and equitable care model for Long COVID.What is the objective?To provide the best-available evidence about care models for persons living with Long COVID.How was the review conducted?We systematically searched seven electronic databases (MEDLINE, Embase, Web of Science, COVID-END, L-OVE, CDRS and WHO Ovid) on May 27th, 2021.Two independent reviewers screened title, abstract and full text.We included studies reporting on 1- persons living with Long COVID (post- hospitalized and community based) and 2- a specific care model (i.e., dedicated clinic, care pathway).We extracted characteristic of studies, referral pathways, clinical settings of care model, healthcare professions included in the care models, care model principles, care model components and reporting of the care model implementation.What did the review find?We found 12 international care models for Long COVID that covers follow-up of patients discharged following a hospitalization and patients who had lived the infection in the community.Most reported elements included in these care models were a coordination unit, primary care pathways, access to multidisciplinary rehabilitation and specialized medical services.The impact and costs of these care models are not yet reported.

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“…Up to a third of people may have symptoms for 12 months or more (Whitaker et al, 2021). Two Long Covid clinics have identified difference between hospitalised and non-hospitalised patients (Heightman et al, 2021;O'Sullivan et al, 2021). Long Covid includes people who have been critically ill (including children with paediatric multi-system inflammatory syndrome) and are experiencing post-intensive care syndrome, some with clear organ damage from the initial viral attack.…”

Section: Beyond the Acute Phase Of Covid-19 Infectionmentioning

confidence: 99%

Children with Long Covid: Co-producing a specialist community public health nursing response

Fanner

Maxwell

2021

Journal of Health Visiting

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Globally, children have been profoundly affected by the Covid-19 pandemic in many ways. While the majority of children with acute Covid-19 infection experience mild illness and fully recover, many go on to experience Long Covid. Long Covid is clinically identified by experience of persistent (and sometimes different) symptoms for several months after the acute infection (even in children who were asymptomatic). There is currently no agreed consensus on the case definition of Long Covid, but real-world data from American health insurance firms and the UK Office for National Statistics report that children may experience intestinal symptoms, pain, breathlessness, cognitive dysfunction and post-exercise malaise. The current understanding of the natural history, diagnostics and treatments of Long Covid is limited, meaning the medical model in isolation is not helpful. Health visitors and school nurses are ideally placed to case-find children with Long Covid and co-produce child and family-centred care.

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Post-COVID assessment in a specialist clinical service: a 12-month, single-centre analysis of symptoms and healthcare needs in 1325 individuals

Cited by 10 publications

References 22 publications

Patient-related outcomes in patients referred to a respiratory clinic with persisting symptoms following non-hospitalised COVID-19

Patient-related outcomes in patients referred to a respiratory clinic with persisting symptoms following non-hospitalised COVID-19

Care Models for Long COVID : A Rapid Systematic Review

Children with Long Covid: Co-producing a specialist community public health nursing response

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