Patients who survive COVID-19 face unexpected, sometimes prolonged side effects. Some struggle with endurance and respiratory weakness as a result of acute respiratory distress syndrome; others face nerve and muscle pathology and complicated mental health issues.
Those effects are compounded in the vulnerable populations essential hospitals serve. Often facing transportation challenges and multiple chronic conditions, these patients struggle to seek coordinated follow-up care.
With Washington State experiencing the nation’s first confirmed case of COVID-19 Jan. 21, association member UW Medicine, in Seattle, was among hospitals on the leading edge of the pandemic. Now, the health system is tackling the virus’ long-term effects through a Post-COVID Telehealth Clinic.
“It seems like the most common presentation that we see is … endurance loss and the fatigue, and difficulty with getting enough endurance to do things like go for walks and take care of things around the house,” says Aaron Bunnell, MD, assistant professor of rehabilitation medicine and director of rehabilitation medicine consults at UW Medicine. “I think that what is surprising is not the categories of effects, but the degree of effect. I’ve been really taken aback at the level of impairment that’s unique to pretty young people.”
The Post-COVID clinic model draws on previous work with patients facing Post–Intensive Care unit Syndrome (PICS), which brings a plethora of physical and mental health challenges. Using a HIPAA-compliant Zoom platform, rehabilitation physicians evaluate referred patients who have been discharged from UW Medicine to determine what therapy they need. The physician refers patients to physical therapy to target endurance, occupational therapy for everyday living functions, and speech therapy or neuropsychiatry to mitigate cognitive issues. The health system is participating in several studies to track health outcomes of these COVID-19 “long-haulers.”
Patients participate in video therapy sessions until they test negative for the virus and can come to in-person appointments. While the telehealth therapy itself is often short-term, Bunnell says patients find comfort in developing a coordinated treatment plan early in the recovery process.
“I think there’s actually a benefit to the patient to just know the process and to know that what they’re experiencing will be addressed — that it’s not just, ‘I’m really suffering and there’s no hope,’ it’s that, ‘Okay, I have a plan, this is what we’ll do going forward, this is what I can work on now, this is what we’ll work on in the future.’ I think that’s really helpful for patients.”
During the COVID-19 pandemic, the U.S. Department of Health and Human Services granted several telehealth flexibilities — including an expanded list of reimbursable telehealth services and waivers for geographic and site-of-service restrictions on the originating site — that facilitated the clinic’s quick launch.
“I think there’s challenges with any clinic, but this was surprisingly easy compared with other clinics I’ve tried to start. I think there was a lot of buy-in from all of our major players. That would be my one key advice: Don’t do it alone, make sure you have each of the disciplines involved,” Bunnell said.
UW Medicine recently opened the clinic to patients without referrals. Bunnell sees the telehealth clinic model as an opportunity to expand access to quality care, especially in UW Medicine’s large catchment area, which extends as far as Alaska, Montana, Wyoming, and Idaho.
“It turns out that a lot of the patients do have issues that benefit from this more multidisciplinary follow-up, and the patients felt like they weren’t necessarily getting that in other settings,” he said. “So I think that there’s a real value in addressing all of these different domains that can be affected after this illness.”
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