Year: 2024
Type: article
Abstract: Background: Post-COVID affects over 2 million people in the United Kingdom, with 75% of these experiencing adverse effects on their activities of daily life.Post-COVID services were set up in response to the emergence of post-COVID in 2020, recognising the complex needs of these patients.The County Durham & Darlington NHS Foundation Trust established a novel approach to providing care via a crossorganisational team of partners from primary care, secondary care, mental health trusts and community organisations to provide a patient-centred approach via an integrated, holistic model of care.The goal of the evaluation was to assess the effectiveness of the interventions offered by the integrated post-COVID pathway.Methods: A multi-disciplinary, cross-organisational team consisting of primary & secondary care medics, physiotherapists, occupational therapists, psychiatrists, psychologists and community practitioners provided care through combined clinics in two geographical locations.Patients attended an initial holistic assessment, after which a personalised care plan was created based on their individual needs, using a shared decision-making approach.Patient reported outcome measures (EQ-5D-5L, PHQ9, GAD7 and MFIS) were completed at both initial assessment and discharge from the service.Results: A total of 2821 patients were referred to the post-COVID service in the 3 years duration from January 2021-January 2024.There were 1524 initial medical assessments and 1668 therapy assessments completed, with a total of 10,027 follow up appointments across all practitioners.Quality of Life: EQ-5D-5L data showed improvement in four out of five domains.Data were collected from 1265 patients, with complete paired before-and-after treatment data available for 223 patients.Overall, for the complete paired data set, patients reported (absolute score reduction): reduced mobility problems (3% absolute score reduction), reduced problems carrying out usual activities (12%), reduced pain or discomfort (10%) and reduced anxiety & depression (8%).p values: mobility, p = 0.25; self-care, p = 0.02; usual activities, p = 0.000005; pain, p = 0.0001 and anxiety/depression, p = 0.009.EQ-VAS scores for n = 1138 for all patients, and n = 190 for complete data sets.For the paired data set there is a 17.2% absolute increase (improvement) in score (p value = <0.0001).Depression: At initial assessment, 69% of the patients scored in either the 'moderate', 'moderately severe' or 'severe' categories on the PHQ-9 for depression.The mean and median scores at pre-treatment were 13.5 and 13, respectively, and at discharge were 10.3 and 9, suggesting a statistically and clinically significant improvement in scores (p < 0.000001).Anxiety: At initial assessment, 45% of the patients scored in either the 'moderate' or 'severe' categories on the GAD7 for their anxiety levels.The mean and median scores at pre-treatment were 10.1 and 9, respectively, and at discharge was 8.3 and 7; suggesting a statistically significant improvement in scores (p < 0.000001).Fatigue data (MFIS): There was a negative difference in the change of scores, indicating that post-treatment scores were generally improved compared to pre-treatment scores.The initial mean score of the paired data set (n = 131) was 56.5, follow up was 38.3, giving an absolute reduction of 32%, p-value <0.0001.The whole data set (n = 1095) initial mean score was 56.7 and follow-up score was 39.5, giving an absolute reduction of 30%.Conclusions: The data show that there is a significant improvement in 4/5 areas of holistic health domains measured by the EQ-5D-5L tool for patients treated in the integrated holistic post-COVID pathway at CDDFT.Furthermore, the data demonstrate a significant improvement in both the total MFIS score and each of the three sub-domains of the MFIS.There is also improvement in both anxiety and depression scores which are clinically and statistically significant.Limitations to the evaluation occurred due to missing data and incomplete data sets due to a combination of a lack of systems in place for data collection during service set up at pace with significant pressures in the system and patients lost to follow up.Despite this, the data is encouraging, and the whole data closely mirrors the paired data sets, which suggests the positive effect is applicable and reproducible across all patients attending the
Source: Lifestyle Medicine
DOI: 10.1002/lim2.70001
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,890
OpenAlex ID: W4402573731