Abstract
Background: This mixed methods project is related to two of the conference themes: Healthy All Around and Collaborative Approaches in Integrated Care. We explored barriers and facilitators to the rapid implementation of a reactive and responsive Long-COVID (LC) integrated care pathway in a UK community setting. The rapidly increasing prevalence of LC, the multisystem complexity of the condition and high patient symptom burden, necessitated an immediate need to develop new clinics for assessment and management of LC patients during the 2020 pandemic.
Approach: We mapped 116 patients’ journeys through this newly developed pathway, identifying the services that were activated according to prevalent symptoms, using a retrospective quantitative cross-sectional analysis of patient data. Primary quantitative outcomes were LC symptoms, referral data (primary reason, source, discharge data, onward specialist referral), anxiety and depressive symptoms, quality of life, functional status, and symptom severity. We also assessed the barriers and facilitators to its implementation and delivery, from the perspective of health care professionals (HCPs) and LC patients via semi-structured qualitative interviews. We applied the Theoretical Domains Framework (TDF) to identify lessons to be learnt about implementing a new, reactive service of integrated care.
Active involvement of HCPs and patients contributed to shaping the service and the aims and study plan of this study, with one LC patient commending the contribution to LC research.
Results: Patients were referred into the service an average of 5.75 months post initial COVID-19 infection. 82% of patients required onward referral to other health professionals, most commonly pulmonary rehabilitation, chronic fatigue specialists, and the specialist COVID-19 Rehab general practitioner embedded within the service. Patients reported having rehabilitation needs, moderate depression, moderate anxiety, and reported difficulties with performing usual activities of daily living at point of care. The TDF domains most relevant to the implementation of the LC pathway, from the perspective of both patients and HCPs, were beliefs about capabilities, environmental context and resources, knowledge, and reinforcement.
Our study provides novel insight into the development of a reactive and responsive, multidisciplinary care pathway. Mapping the patient journey to understand if needs were met and analysing HCPs experiences of establishing a newly developed pathway highlighted key drivers for successful implementation of LC services, such as leadership, multidisciplinary teamwork, transferable skills, and knowledge exchange. Barriers to rapid set up of the service included funding constraints and the rapid evolution of an emergency context. Three quarters of patients accessing the service were White British, confirming the need for inclusion strategies when promoting health services.
Implications: The findings provide evidence-based recommendations for future practice in relation to the initial set-up, implementation, and ongoing delivery of new multidisciplinary LC clinics during an emergency like a pandemic. There is a need for further research to understand i) the longer-term impact on health and wellbeing of multidisciplinary care for LC, ii) the support needs of patients discharged from the service whilst still symptomatic, and iii) barriers and facilitators to accessing LC care amongst patients underrepresented in current research, but overrepresented within the LC population.