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Long Covid service needs and development Dr Harsha Master GP Lead Covid Assessment & Rehabilitation Service HCT June 2022COVID Rehab Pathway Integrated Multidisciplinary Rehabilitation Team: • Rehab Coordinator – • Dieticians Specialised Occupational • Pulmonary Rehabilitation Therapist • Chronic Fatigue • Occupational Therapy • Clinical Psychologist • Physiotherapy • Speech and Language Therapy • COVID Rehab GP Aims – to provide coordinated, holistic care involving both medical assessment and rehabilitation We also work closely with colleagues in secondary care, social care and the voluntary sector. Referrals Received for COVID-19 Rehab Co-ordinationService 140 120 120 111 100 81 81 90 80 70 76 65 61 75 73 78.7% 60 54 46 46 46 58 54 60 60 White 41 39 40 BAME 20 6 Not specified 0 16.0% JulAug 202OctN02D2 22020b M2 202 2ay 2021Aug 202OctN02D2 22021bM02A2022022 5.3% Ethnicity Referral Source General Practitioner 91.4% HCT Community Service 5.0% Gender Acute Hospital Inpatients2.1% Acute Hospital Outpatients0.6% Male Female 34% 66% Other 0.4% NHS Direct / 111 / HUC0.2% Early Intervention Vehicl0.2% Mental Health 0.1% % of Referrals On Type Referral to pulmonary rehabilitation 36% Referral to chronic fatigue syndrome… 20% Referral to mental health team 9% Referral to occupational therapist 6% Referral to physiotherapist 5% Referral to psychologist 4.3% Referral to community-based nurse 3.8% Referral to respiratory physician 3.0% Referral to speech and language therapy… 2.6% Referral to ear, nose and throat service 2.0% Referral to dietitian 1.8% Referral to cardiology service 1.5% Other referral 1.4% Referral to computerised tomography… 0.8% Referral to respiratory nurse speciali0.8% Referral to voluntary service0.7% Referral to neurology service 0.6% Referral for open MRI scan 0.4% Refer to weight management programme 0.2% Referral to accident and emergency service 0.1% Referral to district nurs0.1% Referral to Community Navigator 0.1% Referral to adult care service0.1% Referral to dermatology service0.1% Referral to tissue viability nurse speci0.1%tCHALLENGES ❑ NEW ILLNESS – COMPLEX PRESENTATION ❑ LACK OF EVIDENCE, CAUTIOUS NATIONAL GUIDANCE ❑ OPTIMUM TREATMENT & PATHWAY DESIGN STILL UNCLEAR ❑ FUNDING ❑ RECRUITMENT ❑ VOCATIONAL REHAB What have we learned? ❑ A jointly led service and a multidisciplinary approach offering tailored medical assessment, investigations, treatment and rehabilitation is essential to facilitating a faster recovery. ❑ A specialised rehabilitation coordinator triaging patients at first entry, package of care across the pathwayt, a personalised coordinated ❑ holistic medical assessment, organise further investigations, further specialist review ❑ Using a questionnaire such as the COVID-19 Yorkshire Rehabilitation Scale is useful in documenting symptoms, their severity and any functional disability. ❑ Discussion of complex patients at a multidisciplinary team meeting enables shared clinical decision making, further learning and reflection and helps with service improvement and innovation ❑ Consider the functional, emotional, psychological, and financial impacts of COVID-19—our pathway works an integrated way with health, & the voluntary sector mental health, social care, occupational ❑ A slow-stream rehabilitation approach has been found to work bestHow does our team work? • Pulmonary Rehab –SOB & • Chronic Fatigue Team - Severe dysfunctional breathing fatigue management, pacing advice, sleep issues, chronic pain • ENT & Speech and Language Therapy – Dysfunctional voice and • Clinical Psychologist – PTSD, swallow issues cognitive assessments • Dietician - Loss of taste, GI issues, • IAPT - Depression and anxiety low histamine diet • Respiratory COVID Recovery - • Physiotherapy - Musculoskeletal Respiratory review, lung function pain, improving mobility tests, CT/CTPA • Occupational Therapy - Cognitive • Cardiology – Holter monitor, assessments, fatigue, return to cardiology review, ECHO, cardiac work MRI, stress test, CTCACASESTUDY CASE OUTLINE 64 year old female Covid symptoms in Referred into the Covid positive March Covid Rehab Service Specialist COVID GP March 2020 2020 No test available but & triage via Rehab review (HM) PMH – unprovoked PE Coordinator in 2016- fully antibodypositive investigated – no cause found Ongoing symptoms of Covid Rehab MDT Referred for (HCT/HPFT/ENHT) Cough & SOB ( O2 sats CTPA & Lung discussions dropping to 94% on Function tests exertion) Seen early at home by Fatigue +++ Referred to ICRS team who identified cardiology the low O2 levels. Palpitations 24 hour tape Light-headedness – & worse on standing Pulmonary rehab; physical ECHO normal rehab (mobilisation); and bending Low mood & anxiety Breathlessness Cough Oxygen Desaturations Referral to IAPT Fatigue Symptoms post-COVID Significantly Anxiety & improved Referral to Chronic depression Fatigue Service Palpitation Dizziness s RECOVERY & HOLISTIC CARE Without effective treatment, recovery is typically very slow – many patients can remain symptomatic up to 2 years or longer after their initial infection Lifestyle measures such as minimising stress, sleep optimisation, pacing and improving diet are imperative to recovery and can help to avoid an exacerbation of symptoms and post-exertional malaise. Pacing can help to break the boom and bust cycle A flexible, patient-centred, tailored return to work plan is crucial for patients with long COVIDFUTURE PLANS Developing a community offer & collaborative working Working with PUBLIC HEALTH - to provide support in developing community management for patients, to improve patient outcomes and facilitate self- • VOLUNTARY SECTOR - Developing training programmes & providing support for social prescribers managing Long Covid patients in their local communities • VOCATIONAL REHAB - Liaising with the Health Protection Board to provide guidance, training programmes and events for local businesses, Human Resources and Occupational Health to support return to work plans • SPORTS & EXERCISE – Developing and supporting community based physical activity programs for patients with Long Covid Disability (LD) Specialist nurses and LD carers groups to support LD people with Long Covid