Post-COVID care delivery: The experience from an Irish tertiary centre’s post-COVID clinic

Abstract

Background The long-term effects of SARS-CoV-2 infection and optimal follow-up approach are not well-recognised. Here we describe the implementation of a post-COVID clinic in an Irish tertiary centre after the first wave of the pandemic. This study describes the characteristics of our patient cohort and the operations and outcomes of the clinic, exploring some of the risk factors for developing post-COVID syndrome and the appropriateness of the triage system employed. Methods All SARS-CoV-2 positive patients from March 10th to June 14th 2020 were telephone-triaged as red, amber or green based on ongoing symptoms with clinic appointments scheduled accordingly. All clinic visits were face-to-face with the infectious diseases medical team and a proforma for each patient was completed. Data were collected retrospectively by reviewing the proformas and the electronic medical record (EMR). Results 311 patients attended the clinic. Median time from illness to clinic appointment was 95 days (IQR 77–105.5). 204 patients (66%) were female, 192 (62%) were hospital staff, and the median age was 43 years (IQR 31–53). 138 patients (44%) had required hospital admission. At their first clinic visit 219 patients (70%) had ongoing symptoms. A further appointment was made for 62 patients (20%). 34 patients (11%) were discussed at an MDT meeting, and 55 (18%) were referred onward to a specialist service. 85% of those triaged green, 73% of those triaged amber, and 39% of those triaged red did not receive further follow up after one clinic visit. Patients were more likely to require follow up with reported dyspnoea (OR 5.6; 95% CI 2.8–11.3; p <0.001), cough (OR 3.0; 95% CI 1.1–8.4, p = 0.04), and palpitations (OR 3.6; 95% CI 1.0–12.3; p = 0.04). Female sex was associated with increased odds of a higher triage category (OR 1.8; 95% CI 1.08 to 3.20; p = 0.02), as was requiring admission to hospital (OR 4.0; 95% CI 2.34 to 6.90; p < 0.001). Conclusion The long-term effects of COVID-19 are significant with 70% of our cohort experiencing persistent symptoms. Persistent dyspnoea, cough and palpitations were associated with increased need for follow up. This study also suggests that a traffic light telephone-triage service followed by a face-to-face medical-led clinic could be an effective way of identifying patients who require further management.

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish General Practitioners’ and people living with Long COVID: a qualitative study

“…This study adds to that growing evidence-base and demonstrates the influence of the condition on a sample of PwLC living in Scotland almost 3-years on from the start of the pandemic. The persisting prevalence and impact of Long COVID on people’s lives further emphasises the need for support and services such as community rehabilitation to be available, in keeping with recommendations [1 6 8].…”

“…During this time period, we observed that in some areas, there were low numbers of PwLC receiving community rehabilitation services [15]. We sought approval for an amendment to the study (Ref: 21/WA/0118 A03) to understand potential reasons for these low numbers, in the context of the increasing number of PwLC, recommendations for providing community rehabilitation to PwLC [6 8 22] and knowledge that services existed across Scotland [12]. The study reported here aimed to address two questions: i) what are the perceptions and experiences of PwLC on accessing rehabilitation for Long COVID?…”

“…The National Institute for Health and Care Excellence (NICE) rapid guideline on Long-term effects of COVID-19 recommends that individuals have access to rehabilitation that is personalised and multi-disciplinary in nature [1]. Subsequent studies have emphasised the importance of this approach [6–8]. However, uncertainty remains around the effectiveness of rehabilitation, with research ongoing [9 10].…”

Exploring the perceptions and experiences of community rehabilitation for Long COVID from the perspectives of Scottish general practitioners’ and people living with Long COVID: a qualitative study

“…2 In the UK, 1.9 million people (2.9% of the population) had self-reported LC as of March 2023. 3 Rehabilitation for people with LC is recommended in practice guidelines 1 4 and research, [5][6][7] with UK guidelines recommending personalised and multidisciplinary services. 1 Rehabilitation can be defined as intervention/s aimed at optimising function and reducing disability.…”