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Miller A, Song N, Sivan M, Chowdhury R, Burke MR. Identifying the needs of people with long COVID: a qualitative study in the UK. BMJ Open 2024; 14:e082728. [PMID: 38904135 DOI: 10.1136/bmjopen-2023-082728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES To identify the needs of people with long COVID (LC) in the UK. DESIGN Qualitative study using the Framework Analysis to analyse focus group discussions. PARTICIPANTS 25 adults with LC aged 19-76 years including 17 men and 8 women. Average disease duration was 80.1 weeks. SETTING Eight focus groups were conducted in April 2023 online and in-person at the University of Leeds (UoL), UK. Recruitment routes included advertisement via Leeds Community Healthcare services, the English National Opera Breathe Programme and within the UoL. RESULTS Three key themes/needs were identified. (Theme 1) Support systems including community groups, disability benefits, clinical services and employment support should be accessible and tailored to the needs of people with LC. (Theme 2) Research should investigate the physiology of symptoms, new clinical tests and treatment interventions to improve clinical understanding of the condition and symptom management. (Theme 3) Societal awareness should be promoted via local and national initiatives to educate the public about the condition and reduce stigma. CONCLUSIONS Participants experienced varied and individual challenges to daily life due to LC. There is a need for government acknowledgement of LC as a disability to ensure people with LC have access to disability support and legal protection. Policy development should be patient-driven and acknowledge the individual needs of people with LC in order to improve their quality of life.
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Affiliation(s)
- Amy Miller
- School of Psychology, University of Leeds, Leeds, UK
| | - Ning Song
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Manoj Sivan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
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Hunt K, Maclean A, Locock L, O'Dwyer C, Nettleton S, Ziebland S, Wild C. Young adults' experiences of biographical retrogression whilst living with long COVID. SOCIOLOGY OF HEALTH & ILLNESS 2024. [PMID: 38864760 DOI: 10.1111/1467-9566.13798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/04/2024] [Indexed: 06/13/2024]
Abstract
During the early years (2020-2021) of the COVID-19 pandemic, relatively little attention focused on experiences of people with long-lasting symptoms, particularly young adults who were commonly understood to be invulnerable to serious effects of the virus. Drawing on narrative interviews with 15 adults in their twenties and living in the UK when they became ill with long COVID, we explore contextual factors which made their long COVID illness experience, and the wholescale disruption to their lives, challenging. We propose that existing adaptations of the concept of biographical disruption are problematic for this group, and instead suggest that 'biographical retrogression' may more accurately reflect these young adults' experiences. For many of these young adults, their illness occurred at a crucial stage in forming or solidifying (presumed) adult trajectories. Secondly, the recency of long COVID did not allow for comparison with an existing 'grand narrative' of recovery, so the future course of their illness was not just unknown for them as individuals; there was no prognostic map against which to assess their symptoms. Thirdly, the lives of people with long COVID have been disrupted in the context of global societal disruption by the same virus, rendering their experiences both topical yet invisible.
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Affiliation(s)
- Kate Hunt
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Alice Maclean
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | | | | | - Sue Ziebland
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Cervantee Wild
- Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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MacEwan SR, Rahurkar S, Tarver WL, Forward C, Eramo JL, Teuschler L, Gaughan AA, Rush LJ, Stanwick S, McConnell E, Schamess A, McAlearney AS. Patient Experiences Navigating Care Coordination For Long COVID: A Qualitative Study. J Gen Intern Med 2024; 39:1294-1300. [PMID: 38308155 PMCID: PMC11169119 DOI: 10.1007/s11606-024-08622-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/09/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how to best evaluate, diagnose, and treat long COVID, which presents challenges for patients as they seek care. OBJECTIVE Understand experiences of patients as they navigate care for long COVID. DESIGN Qualitative study involving interviews with patients about topics related to seeking and receiving care for long COVID. PARTICIPANTS Eligible patients were at least 18 years of age, spoke English, self-identified as functioning well prior to COVID infection, and reported long COVID symptoms continued to impact their lives at 3 months or more after a COVID infection. APPROACH Patients were recruited from a post-COVID recovery clinic at an academic medical center from August to September 2022. Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. KEY RESULTS Participants (n=21) reported experiences related to elements of care coordination: access to care, evaluation, treatment, and ongoing care concerns. Some patients noted access to care was facilitated by having providers that listened to and validated their symptoms; other patients reported feeling their access to care was hindered by providers who did not believe or understand their symptoms. Patients reported confusion around how to communicate their symptoms when being evaluated for long COVID, and they expressed frustration with receiving test results that were normal or diagnoses that were not directly attributed to long COVID. Patients acknowledged that clinicians are still learning how to treat long COVID, and they voiced appreciation for providers who are willing to try new treatment approaches. Patients expressed ongoing care concerns, including feeling there is nothing more that can be done, and questioned long-term impacts on their aging and life expectancy. CONCLUSIONS Our findings shed light on challenges faced by patients with long COVID as they seek care. Healthcare systems and providers should consider these challenges when developing strategies to improve care coordination for patients with long COVID.
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Affiliation(s)
- Sarah R MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA.
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.
| | - Saurabh Rahurkar
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Willi L Tarver
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Division of Cancer Prevention and Control, The Ohio State University, Columbus, OH, USA
| | - Cortney Forward
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Jennifer L Eramo
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Lauren Teuschler
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Alice A Gaughan
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Laura J Rush
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Stacy Stanwick
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Erin McConnell
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Andrew Schamess
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
- Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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Kalfas M, Jolley C, Hart N, Rafferty GF, Duncan EL, Nicholson T, Ashworth M, Brewin D, Barrett B, Witard OC, Ridge D, Chalder T. Exploring the Experiences of Living With the Post-COVID Syndrome: A Qualitative Study. Health Expect 2024; 27:e14108. [PMID: 38898594 DOI: 10.1111/hex.14108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Many people experience persistent symptoms for more than 12 weeks following SARS-CoV-2 infection, which is known as post-COVID-19 condition (PCS) or Long COVID (LC). PCS can impair people's quality of life and daily functioning. However, there is a lack of in-depth research exploring the PCS patient journey, as well as gendered aspects of patients' experiences. METHODS Nineteen semi-structured qualitative interviews were conducted with people living with PCS in the United Kingdom (13 women, 6 men). Interviews were transcribed verbatim and analysed inductively using reflexive thematic analysis. RESULTS Five main themes were identified: 'Symptom dismissal', 'Lack of information and support', 'Life before and after Long COVID', 'Psychological impact' and 'Acceptance'. A shift overtime to self-management of symptoms was evident. These themes represent different stages of patients' PCS journey. Narratives indicated that women highlighted dismissal by healthcare professionals (HCPs), which was not as prominent in men's narratives. In addition, women went into more detail about the psychological impact of PCS compared to men. CONCLUSION Women with PCS reported symptom dismissal by HCPs, which may have delayed their diagnosis and negatively affected their well-being. We were not able to explore the experiences of people from non-conforming gender groups. Raising awareness of these issues among HCPs, particularly general practitioners, could improve patient care in PCS. PATIENT OR PUBLIC CONTRIBUTION Patient and public involvement consisted of people who took part in the interviews and commented on the themes' interpretation and study conclusions.
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Affiliation(s)
- Michail Kalfas
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Caroline Jolley
- Centre for Human and Applied Physiological Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
- King's College Hospital NHS Foundation Trust, London, UK
| | - Nicholas Hart
- Centre for Human and Applied Physiological Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
- Lane Fox Clinical Respiratory Physiology Research Centre, Guy's & St Thomas's NHS Foundation Trust, London, UK
| | - Gerrard F Rafferty
- Centre for Human and Applied Physiological Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
| | - Emma L Duncan
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Guy's & St Thomas's NHS Foundation Trust, London, UK
| | - Timothy Nicholson
- Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Mark Ashworth
- School of Life Course & Population Sciences, King's College London, Guy's Campus, London, UK
| | - Debbie Brewin
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Barbara Barrett
- School of Life Course & Population Sciences, King's College London, Guy's Campus, London, UK
| | - Oliver C Witard
- Centre for Human and Applied Physiological Sciences, King's College London, Faculty of Life Sciences & Medicine, London, UK
| | - Damien Ridge
- School of Social Sciences, University of Westminster, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Trisyani Y, Mahendra D, Nuraeni A. Lessons Learned from the Lived Experiences of COVID-19 ICU Survivors Who are Struggling Through Critical Conditions and Surviving to Champion Life: A Qualitative Study. J Multidiscip Healthc 2024; 17:2659-2669. [PMID: 38828267 PMCID: PMC11141573 DOI: 10.2147/jmdh.s380389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background Due to the coronavirus disease 2019 (COVID-19) pandemic, millions of lives were lost globally, including in Indonesia. Some patients with COVID-19 may experience severe symptoms of hypoxia, while some may be critically ill and admitted to the intensive care unit (ICU) for survival. Purpose This study aimed to understand the lived experiences of COVID-19 ICU survivors who were in a critical condition. Methods This phenomenological study used semistructured interviews with nine participants who were COVID-19 ICU survivors. Data analysis was performed using the Colaizzi approach. Results The phenomenon of the lived experiences of COVID-19 ICU survivors was presented in seven subthemes and four main themes: struggling in a state of helplessness, fostering a positive spirit from within, amplifying the support from nurses and doctors, and strengthening the connection with family and the Almighty. These themes indicated the essential aspects of psychosocial support needed to boost strength and energy and elevate the body's immune system, which is crucial to champion life through critical conditions. Conclusion The new insight resulting from the study is shown in the four main themes, which play a significant role in elevating the healing process and enabling patients to survive critical conditions. Therefore, this study recommends the importance of psychosocial support for patients with critical conditions, which involves family and their significant others, and facilitating the connection between the patient and God.
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Affiliation(s)
- Yanny Trisyani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Donny Mahendra
- Vocational Faculty, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Aan Nuraeni
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
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Cooper K, Duncan E, Hart-Winks E, Cowie J, Shim J, Stage E, Tooman T, Alexander L, Love A, Morris JH, Ormerod J, Preston J, Swinton P. 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. BMJ Open 2024; 14:e082830. [PMID: 38749696 PMCID: PMC11097876 DOI: 10.1136/bmjopen-2023-082830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVES To explore the experience of accessing Long COVID community rehabilitation from the perspectives of people with Long COVID and general practitioners (GPs). DESIGN Qualitative descriptive study employing one-to-one semistructured virtual interviews analysed using the framework method. SETTING Four National Health Service Scotland territorial health boards. PARTICIPANTS 11 people with Long COVID (1 male, 10 female; aged 40-65 (mean 53) and 13 GPs (5 male, 8 female). RESULTS Four key themes were identified: (1) The lived experience of Long COVID, describing the negative impact of Long COVID on participants' health and quality of life; (2) The challenges of an emergent and complex chronic condition, including uncertainties related to diagnosis and management; (3) Systemic challenges for Long COVID service delivery, including lack of clear pathways for access and referral, siloed services, limited resource and a perceived lack of holistic care, and (4) Perceptions and experiences of Long COVID and its management, including rehabilitation. In this theme, a lack of knowledge by GPs and people with Long COVID on the potential role of community rehabilitation for Long COVID was identified. Having prior knowledge of rehabilitation or being a healthcare professional appeared to facilitate access to community rehabilitation. Finally, people with Long COVID who had received rehabilitation had generally found it beneficial. CONCLUSIONS There are several patient, GP and service-level barriers to accessing community rehabilitation for Long COVID. There is a need for greater understanding by the public, GPs and other potential referrers of the role of community rehabilitation professionals in the management of Long COVID. There is also a need for community rehabilitation services to be well promoted and accessible to the people with Long COVID for whom they may be appropriate. The findings of this study can be used by those (re)designing community rehabilitation services for people with Long COVID.
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Affiliation(s)
- Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Edward Duncan
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | - Erin Hart-Winks
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Julie Cowie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Emma Stage
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Tricia Tooman
- NMAHP Research Unit, University of Stirling, Stirling, UK
| | | | | | | | | | - Jenny Preston
- NMAHP Research Unit, University of Stirling, Stirling, UK
- Occupational Therapy, NHS Ayrshire and Arran, Irvine, UK
| | - Paul Swinton
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
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Burton-Fisher W, Gordon K. Holding the hope? Therapist and client perspectives on long COVID recovery: A Q-methodology. Br J Health Psychol 2024. [PMID: 38735864 DOI: 10.1111/bjhp.12724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/12/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Long COVID is a global health concern which has debilitating effects on the individual experiencing it. In the United Kingdom, psychological therapies are being offered to people with long COVID, although the evidence for these therapies is yet to be demonstrated. This research aimed to understand how therapists and clients define and understand recovery from long COVID, and use hope theory to interpret the results. METHODS An online Q-methodology was employed, where participants sorted a range of statements pertaining to long COVID recovery based on their level of agreement with them. These arranged statements (Q-sorts) were collated and factor analysed to explore and compare underlying perspectives. RESULTS Sixteen participants were recruited for the study, including eleven clients, four IAPT therapists and one therapist working in the broader long COVID pathway. A four-factor model is reported, including (1) Psychological Pathways to Recovery, (2) Social Context and Agency, (3) Physiological Goals of Recovery and (4) Personal Meaning Making. All IAPT therapists loaded onto the psychological pathways factor, whereas the remaining participants shared more diverse perspectives. CONCLUSIONS The belief that long COVID recovery was possible, taken as an indicator of hopefulness, was rated highest for Factor 1, Psychological Pathways to Recovery, and Factor 3, Physiological Recovery Goals. This suggested that having a clear definition of recovery, or clear guidance on how to intervene, promoted hopefulness and, theoretically, well-being. However, clients reported experiences of being invalidated and disbelieved by health professionals, with psychological explanations sometimes being experienced as dismissive and invalidating. Clinical implications and future research directions are discussed.
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Affiliation(s)
| | - Kim Gordon
- Professional Doctorate in Clinical Psychology, Staffordshire University, Staffordshire, United Kingdom
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Jeffrey K, Woolford L, Maini R, Basetti S, Batchelor A, Weatherill D, White C, Hammersley V, Millington T, Macdonald C, Quint JK, Kerr R, Kerr S, Shah SA, Rudan I, Fagbamigbe AF, Simpson CR, Katikireddi SV, Robertson C, Ritchie L, Sheikh A, Daines L. Prevalence and risk factors for long COVID among adults in Scotland using electronic health records: a national, retrospective, observational cohort study. EClinicalMedicine 2024; 71:102590. [PMID: 38623399 PMCID: PMC11016856 DOI: 10.1016/j.eclinm.2024.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024] Open
Abstract
Background Long COVID is a debilitating multisystem condition. The objective of this study was to estimate the prevalence of long COVID in the adult population of Scotland, and to identify risk factors associated with its development. Methods In this national, retrospective, observational cohort study, we analysed electronic health records (EHRs) for all adults (≥18 years) registered with a general medical practice and resident in Scotland between March 1, 2020, and October 26, 2022 (98-99% of the population). We linked data from primary care, secondary care, laboratory testing and prescribing. Four outcome measures were used to identify long COVID: clinical codes, free text in primary care records, free text on sick notes, and a novel operational definition. The operational definition was developed using Poisson regression to identify clinical encounters indicative of long COVID from a sample of negative and positive COVID-19 cases matched on time-varying propensity to test positive for SARS-CoV-2. Possible risk factors for long COVID were identified by stratifying descriptive statistics by long COVID status. Findings Of 4,676,390 participants, 81,219 (1.7%) were identified as having long COVID. Clinical codes identified the fewest cases (n = 1,092, 0.02%), followed by free text (n = 8,368, 0.2%), sick notes (n = 14,469, 0.3%), and the operational definition (n = 64,193, 1.4%). There was limited overlap in cases identified by the measures; however, temporal trends and patient characteristics were consistent across measures. Compared with the general population, a higher proportion of people with long COVID were female (65.1% versus 50.4%), aged 38-67 (63.7% versus 48.9%), overweight or obese (45.7% versus 29.4%), had one or more comorbidities (52.7% versus 36.0%), were immunosuppressed (6.9% versus 3.2%), shielding (7.9% versus 3.4%), or hospitalised within 28 days of testing positive (8.8% versus 3.3%%), and had tested positive before Omicron became the dominant variant (44.9% versus 35.9%). The operational definition identified long COVID cases with combinations of clinical encounters (from four symptoms, six investigation types, and seven management strategies) recorded in EHRs within 4-26 weeks of a positive SARS-CoV-2 test. These combinations were significantly (p < 0.0001) more prevalent in positive COVID-19 patients than in matched negative controls. In a case-crossover analysis, 16.4% of those identified by the operational definition had similar healthcare patterns recorded before testing positive. Interpretation The prevalence of long COVID presenting in general practice was estimated to be 0.02-1.7%, depending on the measure used. Due to challenges in diagnosing long COVID and inconsistent recording of information in EHRs, the true prevalence of long COVID is likely to be higher. The operational definition provided a novel approach but relied on a restricted set of symptoms and may misclassify individuals with pre-existing health conditions. Further research is needed to refine and validate this approach. Funding Chief Scientist Office (Scotland), Medical Research Council, and BREATHE.
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Affiliation(s)
- Karen Jeffrey
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Lana Woolford
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Rishma Maini
- Public Health Scotland, Glasgow and Edinburgh, UK
| | | | - Ashleigh Batchelor
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Weatherill
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Chris White
- Patient and Public Contributors, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | | | | | - Jennifer K. Quint
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Robin Kerr
- NHS Borders, Melrose, UK
- NHS Dumfries & Galloway, Dumfries, UK
| | - Steven Kerr
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Igor Rudan
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Colin R. Simpson
- Usher Institute, University of Edinburgh, Edinburgh, UK
- School of Health, Wellington Faculty of Health, Victoria University of Wellington, Wellington, NZ
| | - Srinivasa Vittal Katikireddi
- Public Health Scotland, Glasgow and Edinburgh, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Chris Robertson
- Public Health Scotland, Glasgow and Edinburgh, UK
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - Lewis Ritchie
- Academic Primary Care, University of Aberdeen, Aberdeen, UK
- Institute of Applied Health Sciences, University of Aberdeen, UK
| | - Aziz Sheikh
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Luke Daines
- Usher Institute, University of Edinburgh, Edinburgh, UK
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Marques FRDM, Laranjeira C, Carreira L, Gallo AM, Baccon WC, Goes HDF, Salci MA. Managing long COVID symptoms and accessing health services in Brazil: A grounded theory analysis. Heliyon 2024; 10:e28369. [PMID: 38571660 PMCID: PMC10988007 DOI: 10.1016/j.heliyon.2024.e28369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
Background The worldwide community has shown significant interest in researching the management of Long COVID. However, there is scarce evidence about the daily experiences of people living with Long COVID and their insights into the healthcare services provided to them. Aims This study aims to understand the experience of Long COVID sufferers with their symptoms and in accessing health services. Method We employed Charmaz's grounded theory methodology, informed by constructivism, and applied the COREQ guidelines for qualitative research. Sixty-six Brazilians living with Long COVID participated in the study. The data was collected using semi-structured telephone interviews and analyzed using a constant comparative process. Findings The findings refer firstly to the consequences of persistent Long COVID symptoms. Secondly, they describe how the disease trajectory required Long COVID sufferers to reorganize their routines and develop adaptive strategies. Lastly, they reflect a diverse array of both positive and negative interactions inside the healthcare system conveyed by individuals suffering from Long COVID. These elements converge towards the core category of the study: "The limbo of Long COVID sufferers: between the persistence of symptoms and access to health services". Conclusions Long COVID is characterized by its varied nature, including a range of physical and emotional repercussions experienced by individuals. There is a need for enhanced comprehension and discourse about Long COVID across several domains, including the general public, policy-making entities, and healthcare professionals. In this sense, the development of specialized services or the reinforcement of existing services to support long COVID sufferers is imperative.
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Affiliation(s)
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic University of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic University of Leiria, Campus 5, Rua das Olhalvas, 2414-016 Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801, Évora, Portugal
| | - Lígia Carreira
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Adriana Martins Gallo
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Wanessa Cristina Baccon
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Herbert de Freitas Goes
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
| | - Maria Aparecida Salci
- Departamento de Pós-Graduação em Enfermagem, Universidade Estadual de Maringá, Avenida Colombo, 5790—Campus Universitário, Maringá, 87020-900, PR, Brazil
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Fang C, Baz SA, Sheard L, Carpentieri JD. "They seemed to be like cogs working in different directions": a longitudinal qualitative study on Long COVID healthcare services in the United Kingdom from a person-centred lens. BMC Health Serv Res 2024; 24:406. [PMID: 38561719 PMCID: PMC10986002 DOI: 10.1186/s12913-024-10891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has presented significant challenges to the already over-stretched healthcare system in the United Kingdom (UK). These challenges are particularly pronounced for people living with the novel condition of Long COVID (LC) as they often face persistent and fluctuating symptoms, encountering prolonged uncertainty when seeking medical support. Despite a growing understanding of the healthcare challenges associated with LC, existing qualitative studies have predominantly focused on individual experiences rather than examining the structural aspects of healthcare. METHODS A longitudinal qualitative study with 80 participants and 12 healthcare practitioners was conducted in the UK to explore the healthcare experiences of those with LC. In total, 178 interviews (with attrition) were collected across two rounds, from November 2021 to March 2022, and from June to October 2022. RESULTS Embracing a person-centred framework that recognises and nurtures interconnected individual, relational, and existential needs, we investigated healthcare experiences related to LC across primary, secondary, and specialist integrated care. Using this perspective, we identified three overarching themes. Theme 1 addresses the persistent hurdle of accessing primary care as the initial point of contact for LC healthcare; Theme 2 underscores the complexity of navigating secondary care; and Theme 3 encapsulates the distinctive challenges of developing LC integrated care. These themes are interlinked, as people with LC often had to navigate or struggle between the various systems, with practitioners seeking to collaborate across the breadth of their professional responsibilities. CONCLUSION From a person-centred approach, we were able to identify the needs of those affected by lasting LC symptoms and comprehend how health services intricately influence these needs. The focus on healthcare systems also captures the nuanced impact that continuing healthcare struggles can have on people's identity. As such, our findings provide evidence to inform a more effective and sustainable delivery of person-centred care for people with LC across various healthcare settings and over time.
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Affiliation(s)
- Chao Fang
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK.
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | - J D Carpentieri
- Department of Education, Practice and Society, Institute of Education, University College London, London, UK
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11
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Clutterbuck D, Ramasawmy M, Pantelic M, Hayer J, Begum F, Faghy M, Nasir N, Causer B, Heightman M, Allsopp G, Wootton D, Khan MA, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Clarke R, Mcfarland S, Gabbay M, Banerjee A, Alwan NA. Barriers to healthcare access and experiences of stigma: Findings from a coproduced Long Covid case-finding study. Health Expect 2024; 27:e14037. [PMID: 38634418 PMCID: PMC11024953 DOI: 10.1111/hex.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND AIM Long Covid is often stigmatised, particularly in people who are disadvantaged within society. This may prevent them from seeking help and could lead to widening health inequalities. This coproduced study with a Community Advisory Board (CAB) of people with Long Covid aimed to understand healthcare and wider barriers and stigma experienced by people with probable Long Covid. METHODS An active case finding approach was employed to find adults with probable, but not yet clinically diagnosed, Long Covid in two localities in London (Camden and Merton) and Derbyshire, England. Interviews explored the barriers to care and the stigma faced by participants and were analysed thematically. This study forms part of the STIMULATE-ICP Collaboration. FINDINGS Twenty-three interviews were completed. Participants reported limited awareness of what Long Covid is and the available pathways to management. There was considerable self-doubt among participants, sometimes reinforced by interactions with healthcare professionals (HCPs). Participants questioned their deservedness in seeking healthcare support for their symptoms. Hesitancy to engage with healthcare services was motivated by fear of needing more investigation and concerns regarding judgement about the ability to carry out caregiving responsibilities. It was also motivated by the complexity of the clinical presentation and fear of all symptoms being attributed to poor mental health. Participants also reported trying to avoid overburdening the health system. These difficulties were compounded by experiences of stigma and discrimination. The emerging themes reaffirmed a framework of epistemic injustice in relation to Long Covid, where creating, interpreting and conveying knowledge has varied credibility based on the teller's identity characteristics and/or the level of their interpretive resources. CONCLUSION We have codeveloped recommendations based on the findings. These include early signposting to services, dedicating protected time to listening to people with Long Covid, providing a holistic approach in care pathways, and working to mitigate stigma. Regardless of the diagnosis, people experiencing new symptoms must be encouraged to seek timely medical help. Clear public health messaging is needed among communities already disadvantaged by epistemic injustice to raise awareness of Long Covid, and to share stories that encourage seeking care and to illustrate the adverse effects of stigma. PATIENT OR PUBLIC CONTRIBUTION This study was coproduced with a CAB made up of 23 members including HCPs, people with lived experience of Long Covid and other stakeholders.
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Affiliation(s)
- Donna Clutterbuck
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
| | - Mel Ramasawmy
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Marija Pantelic
- Brighton and Sussex Medical SchoolUniversity of SussexFalmerUK
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Jasmine Hayer
- PPIE Co‐applicant for STIMULATE‐ICPLondonUK
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Fauzia Begum
- University Hospitals of Derby and Burton NHS Foundation TrustDerbyshireUK
| | - Mark Faghy
- Clinical Exercise and Rehabilitation Research CentreUniversity of DerbyDerbyUK
| | - Nayab Nasir
- Department of Health and Social CareOffice for Health Improvement and DisparitiesUK
| | | | | | | | - Dan Wootton
- Clinical Infection Microbiology and ImmunologyUniversity of LiverpoolLiverpoolUK
- Liverpool University Hospitals NHS Foundation TrustLiverpoolUK
| | - M. Asad Khan
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Manchester University Hospitals NHS Foundation TrustManchesterUK
| | - Claire Hastie
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Support CharityLondonUK
| | - Monique Jackson
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Clare Rayner
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Darren Brown
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Chelsea and Westminster Hospital NHS Foundation TrustLondonUK
| | - Emily Parrett
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Geraint Jones
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Rowan Clarke
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
| | - Sammie Mcfarland
- Member of the Community Advisory Board as person with lived experience of Long CovidSouthamptonUK
- Long Covid Kids CharitySalisburyUK
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West CoastLiverpoolUK
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
| | - Amitava Banerjee
- Institute of Health InformaticsUniversity College LondonLondonUK
| | - Nisreen A. Alwan
- School of Primary CarePopulation Sciences and Medical EducationUniversity of SouthamptonSouthamptonUK
- University Hospital Southampton NHS Foundation TrustSouthamptonUK
- NIHR Applied Research Collaboration WessexSouthamptonUK
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12
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Al-Jabr H, Windle K, Clifton A, Thompson DR, Castle DJ, Ski CF. Patient experiences of the Long COVID-Optimal Health Programme: a qualitative interview study in community settings. BJGP Open 2024; 8:BJGPO.2023.0137. [PMID: 37907337 PMCID: PMC11169993 DOI: 10.3399/bjgpo.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/29/2023] [Accepted: 10/26/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Long COVID (LC) symptoms persist 12 weeks or more beyond the acute infection. To date, no standardised diagnostic or treatment pathways exist. However, a holistic approach has been recommended. This study explored participants' experiences of a Long COVID-Optimal Health Programme (LC-OHP); a psychoeducational self-efficacy programme. AIM To explore perceptions and experiences of people with LC regarding the LC-OHP and identify suggestions to further improve the programme. DESIGN & SETTING Qualitative study with patients with LC recruited through community settings. METHOD This study is part of a wider randomised controlled trial. Eligible participants were aged ≥18 years, have LC, and attended a minimum of five LC-OHP sessions plus a booster session. We interviewed those randomised to the intervention group. Interviews were conducted by an independent researcher and thematically analysed to identify common, emerging themes. RESULTS Eleven participants were interviewed, mostly women from a White British ethnic group (n = 10). Four main themes were identified, reflecting programme benefits and suggestions for improvement. The programme demonstrated potential for assisting patients in managing their LC, including physical health and mental wellbeing. Participants found the programme to be flexible and provided suggestions to adapting it for future users. CONCLUSION Findings support the acceptability of the LC-OHP to people living with LC. The programme has shown several benefits in supporting physical health and mental wellbeing. Suggestions made to further adapt the programme and improve its delivery will be considered for future trials.
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Affiliation(s)
- Hiyam Al-Jabr
- Primary Community and Social Care, University of Keele, Keele, UK
- Midlands Partnership University NHS Foundation Trust, St Georges Hospital, Stafford, UK
| | - Karen Windle
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Andrew Clifton
- School of Health and Sports Sciences, University of Suffolk, Ipswich, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David J Castle
- Department of Psychiatry, University of Tasmania, Tasmania, Australia
- Centre for Mental Health Service Innovation, Tasmania, Australia
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Woldegiorgis M, Cadby G, Ngeh S, Korda RJ, Armstrong PK, Maticevic J, Knight P, Jardine A, Bloomfield LE, Effler PV. Long COVID in a highly vaccinated but largely unexposed Australian population following the 2022 SARS-CoV-2 Omicron wave: a cross-sectional survey. Med J Aust 2024; 220:323-330. [PMID: 38508863 DOI: 10.5694/mja2.52256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/25/2023] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To estimate the prevalence of long COVID among Western Australian adults, a highly vaccinated population whose first major exposure to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was during the 2022 Omicron wave, and to assess its impact on health service use and return to work or study. STUDY DESIGN Follow-up survey (completed online or by telephone). SETTING, PARTICIPANTS Adult Western Australians surveyed 90 days after positive SARS-CoV-2 test results (polymerase chain reaction or rapid antigen testing) during 16 July - 3 August 2022 who had consented to follow-up contact for research purposes. MAIN OUTCOME MEASURES Proportion of respondents with long COVID (ie, reporting new or ongoing symptoms or health problems, 90 days after positive SARS-CoV-2 test result); proportion with long COVID who sought health care for long COVID-related symptoms two to three months after infection; proportion who reported not fully returning to previous work or study because of long COVID-related symptoms. RESULTS Of the 70 876 adults with reported SARS-CoV-2 infections, 24 024 consented to contact (33.9%); after exclusions, 22 744 people were invited to complete the survey, of whom 11 697 (51.4%) provided complete responses. Our case definition for long COVID was satisfied by 2130 respondents (18.2%). The risk of long COVID was greater for women (v men: adjusted risk ratio [aRR], 1.5; 95% confidence interval [CI], 1.4-1.6) and for people aged 50-69 years (v 18-29 years: aRR, 1.6; 95% CI, 1.4-1.9) or with pre-existing health conditions (aRR, 1.5; 95% CI, 1.4-1.7), as well as for people who had received two or fewer COVID-19 vaccine doses (v four or more: aRR, 1.4; 95% CI, 1.2-1.8) or three doses (aRR, 1.3; 95% CI, 1.1-1.5). The symptoms most frequently reported by people with long COVID were fatigue (1504, 70.6%) and concentration difficulties (1267, 59.5%). In the month preceding the survey, 814 people had consulted general practitioners (38.2%) and 34 reported being hospitalised (1.6%) with long COVID. Of 1779 respondents with long COVID who had worked or studied before the infection, 318 reported reducing or discontinuing this activity (17.8%). CONCLUSION Ninety days after infection with the Omicron SARS-CoV-2 variant, 18.2% of survey respondents reported symptoms consistent with long COVID, of whom 38.7% (7.1% of all survey respondents) sought health care for related health concerns two to three months after the acute infection.
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Affiliation(s)
- Mulu Woldegiorgis
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Gemma Cadby
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
| | - Sera Ngeh
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
| | - Paul K Armstrong
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
| | - Jelena Maticevic
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
| | - Paul Knight
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
| | - Andrew Jardine
- Environmental Health Directorate, Western Australia Department of Health, Perth, WA
| | - Lauren E Bloomfield
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
- The University of Notre Dame Australia, Fremantle, WA
| | - Paul V Effler
- Communicable Disease Control Directorate, Western Australia Department of Health, Perth, WA
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14
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Faux-Nightingale A, Saunders B, Burton C, Chew-Graham CA, Somayajula G, Twohig H, Welsh V. Experiences and care needs of children with long COVID: a qualitative study. BJGP Open 2024; 8:BJGPO.2023.0143. [PMID: 37914226 PMCID: PMC11169971 DOI: 10.3399/bjgpo.2023.0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Long COVID, the patient-preferred term, describes symptoms persisting after an acute episode of COVID-19 infection. Symptoms in children and young people (CYP) can affect daily routine, with broader impacts on education, health-related quality of life, and social activities, which may have long-term effects on health and wellbeing. AIM To explore the lived experiences and care needs of CYP with long COVID from the perspectives of CYP with long COVID, their parents, and professionals associated with the care of children and families living with the condition. DESIGN & SETTING CYP and their parent or carer were invited for interview following participation in a cohort study, which recruited the sample from a primary care setting. METHOD Interviews were carried out with four CYP with long COVID (all female, aged 10-17 years); three interviews included a parent. Two focus groups were conducted, which included seven professionals involved with care of CYP or long COVID, from a range of disciplines. Interviews and focus groups were transcribed verbatim, and data analysed thematically using constant comparison techniques. RESULTS The three main themes presented are as follows: living with long COVID; uncertainty surrounding long COVID; and seeking help for symptoms. CONCLUSION Long COVID can severely impact the lives of CYP and their families. CYP and their families need to be listened to by professionals and have any uncertainties acknowledged. It is imperative that agencies working with them understand the condition and its impact, and are able to offer support where needed.
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Affiliation(s)
| | | | - Claire Burton
- School of Medicine, Keele University, Staffordshire, UK
| | | | | | - Helen Twohig
- School of Medicine, Keele University, Staffordshire, UK
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15
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Turk F, Sweetman J, Chew‐Graham CA, Gabbay M, Shepherd J, van der Feltz‐Cornelis C. Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study. Health Expect 2024; 27:e14008. [PMID: 38481384 PMCID: PMC10938067 DOI: 10.1111/hex.14008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Long Covid is an emerging long-term condition, with those affected raising concerns about lack of healthcare support. OBJECTIVE We conducted a qualitative study to identify facilitators and barriers to healthcare access for people with Long Covid, aiming to enhance our understanding of the specific nature of these barriers and how patient experiences may vary. SETTING AND PARTICIPANTS In the context of the Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways (STIMULATE-ICP) Delphi study, a nationally distributed online survey was conducted. Eight patients and eight healthcare practitioners (HCP) were interviewed via telephone or video call. Framework analysis, sensitised by the candidacy theory, was used to identify barriers and facilitators over four levels of access to care. RESULTS Three themes were identified: (i) patients' efforts to navigate emerging pathways for Long Covid, (ii) the patient-HCP interaction and (iii) service resources and structural constraints. Barriers to specialist care included long waiting times, communication gaps across services and a lack of continuity in care. Facilitators included collaborative, patient-centred approaches, patients' active role in their healthcare and blended approaches for appointments. The perspectives of both patients and HCPs largely aligned. DISCUSSION The candidacy framework was valuable in understanding the experiences of people with Long Covid seeking access to healthcare. Individuals perceived themselves as eligible for care, but they often encountered obstacles in obtaining the expected level of care or, in some cases, did not receive it at all. Our findings are discussed in the context of the candidacy model through multiple processes of identification, negotiation, permeability and appearances at health services. These themes seem to be especially important for the emerging new pathway model and are relevant to both primary and secondary care. CONCLUSIONS This study highlights that despite these interviews being conducted two years after the start of the COVID-19 pandemic, people with Long Covid still struggle to access healthcare, emphasising the ongoing need to provide equitable timely healthcare access for people with Long Covid. PATIENT OR PUBLIC CONTRIBUTION People with Long Covid advised on all stages of this research.
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Affiliation(s)
- Fidan Turk
- Department of Health SciencesUniversity of YorkYorkUK
| | | | | | - Mark Gabbay
- Department of Primary Care and Mental HealthUniversity of LiverpoolLiverpoolUK
- NIHR ARC NWCLiverpoolUK
| | | | - Christina van der Feltz‐Cornelis
- Department of Health SciencesUniversity of YorkYorkUK
- Hull York Medical School (HYMS)University of YorkYorkUK
- Institute of Health InformaticsUniversity College LondonLondonUK
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16
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Leggat FJ, Heaton-Shrestha C, Fish J, Siriwardena AN, Domeney A, Rowe C, Patel I, Parsons J, Blair J, Jones F. An exploration of the experiences and self-generated strategies used when navigating everyday life with Long Covid. BMC Public Health 2024; 24:789. [PMID: 38481230 PMCID: PMC10938753 DOI: 10.1186/s12889-024-18267-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Around one in ten people who contract Covid-19 report ongoing symptoms or 'Long Covid'. Without any known interventions to cure the condition, forms of self-management are routinely prescribed by healthcare professionals and described by people with the condition. However, there is limited research exploring what strategies are used to navigate everyday life with Long Covid, and experiences that initiate development of these strategies. Our study aimed to explore the range and influence of self-generated strategies used by people with Long Covid to navigate everyday life within the context of their own condition. METHODS Forming part of the Long Covid Personalised Self-managemenT support co-design and EvaluatioN (LISTEN) project, we conducted a qualitative study using narrative interviews with adults who were not hospitalised with Covid-19. Participants aged over 18 years, who self-identified with Long Covid, were recruited from England and Wales. Data were analysed with patient contributors using a reflexive thematic analysis. RESULTS Eighteen participants (mean age = 44 years, SD = 13 years) took part in interviews held between December 2021 and February 2022. Themes were constructed which depicted 1) the landscape behind the Long Covid experience and 2) the everyday experience of participants' Long Covid. The everyday experience comprised a combination of physical, emotional, and social factors, forming three sub-themes: centrality of physical symptoms, navigating 'experts' and the 'true colour' of personal communities, and a rollercoaster of psychological ambiguity). The third theme, personal strategies to manage everyday life was constructed from participants' unique presentations and self-generated solutions to manage everyday life. This comprised five sub-themes: seeking reassurance and knowledge, developing greater self-awareness through monitoring, trial and error of 'safe' ideas, building in pleasure and comfort, and prioritising 'me'. CONCLUSIONS Among this sample of adults with Long Covid, their experiences highlighted the unpredictable nature of the condition but also the use of creative and wide ranging self-generated strategies. The results offer people with Long Covid, and healthcare professionals supporting them, an overview of the collective evidence relating to individuals' self-management which can enable ways to live 'better' and regain some sense of identity whilst facing the impact of a debilitating, episodic condition. TRIAL REGISTRATION LISTEN ISRCTN36407216.
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Affiliation(s)
- Fiona J Leggat
- Population Health Research Institute, St George's, University of London, London, England, UK
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Celayne Heaton-Shrestha
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK
| | - Jessica Fish
- Department of Clinical Neuropsychology & Clinical Health Psychology, St George's University Hospitals NHS Foundation Trust, London, England, UK
- Mental Health & Wellbeing, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | - Anne Domeney
- LISTEN Lived Experience Advisory Group, London, UK
- Bridges Self-Management, London, England, UK
| | - Carol Rowe
- LISTEN Lived Experience Advisory Group, London, UK
| | - Ian Patel
- LISTEN Lived Experience Advisory Group, London, UK
| | | | - John Blair
- LISTEN Lived Experience Advisory Group, London, UK
| | - Fiona Jones
- Population Health Research Institute, St George's, University of London, London, England, UK.
- Centre for Applied Health and Social Care Research, Faculty of Health, Social Care and Education, Kingston University, London, England, UK.
- Bridges Self-Management, London, England, UK.
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Cruickshank M, Brazzelli M, Manson P, Torrance N, Grant A. What is the impact of long-term COVID-19 on workers in healthcare settings? A rapid systematic review of current evidence. PLoS One 2024; 19:e0299743. [PMID: 38442116 PMCID: PMC10914278 DOI: 10.1371/journal.pone.0299743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 02/11/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Long COVID is a devastating, long-term, debilitating illness which disproportionately affects healthcare workers, due to the nature of their work. There is currently limited evidence specific to healthcare workers about the experience of living with Long COVID, or its prevalence, pattern of recovery or impact on healthcare. OBJECTIVE Our objective was to assess the effects of Long COVID among healthcare workers and its impact on health status, working lives, personal circumstances, and use of health service resources. METHODS We conducted a systematic rapid review according to current methodological standards and reported it in adherence to the PRISMA 2020 and ENTREQ statements. RESULTS We searched relevant electronic databases and identified 3770 articles of which two studies providing qualitative evidence and 28 survey studies providing quantitative evidence were eligible. Thematic analysis of the two qualitative studies identified five themes: uncertainty about symptoms, difficulty accessing services, importance of being listened to and supported, patient versus professional identity and suggestions to improve communication and services for people with Long COVID. Common long-term symptoms in the survey studies included fatigue, headache, loss of taste and/or smell, breathlessness, dyspnoea, difficulty concentrating, depression and anxiety. CONCLUSION Healthcare workers struggled with their dual identity (patient/doctor) and felt dismissed or not taken seriously by their doctors. Our findings are in line with those in the literature showing that there are barriers to healthcare professionals accessing healthcare and highlighting the challenges of receiving care due to their professional role. A more representative approach in Long COVID research is needed to reflect the diverse nature of healthcare staff and their occupations. This rapid review was conducted using robust methods with the codicil that the pace of research into Long COVID may mean relevant evidence was not identified.
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Affiliation(s)
- Moira Cruickshank
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Miriam Brazzelli
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Paul Manson
- Health Services Research Unit, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola Torrance
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
| | - Aileen Grant
- School of Nursing, Midwifery & Paramedic Practice, Robert Gordon University, Aberdeen, United Kingdom
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18
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Barnhill J, Chilcoat A, Kavalakatt B, Mata R, Tiedt M, Roth I. Different but the Same: Common Themes in Illness Experience Among People With Diverse Long COVID Symptoms and the Potential Benefits of Virtual Group Medical Visits. J Patient Exp 2024; 11:23743735241230144. [PMID: 38357361 PMCID: PMC10865942 DOI: 10.1177/23743735241230144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Long coronavirus disease 2019 (COVID-19) is poorly understood, widespread and debilitating. Integrative medical group visits (IMGVs) provide group medical care virtually or in person and are reimbursed by insurance payors. IMGV introduces integrative modalities such as mindfulness, nutrition, and acupressure in a person-centered, supportive, and educational environment. To evaluate a telehealth IMGV program called Nourish to Flourish (N2F) for patients with long COVID, three researchers conducted a qualitative analysis of pre- and post-group individual interviews. Twenty-five patients provided interviews, of which fifteen included pre- and post-group individual interviews. Main themes were unpredictable symptom patterns, a common range of emotions associated with long COVID experience, reconceptualizing self-identity, multiple barriers to care in conventional settings, and connections formed in N2F. Although symptoms varied, N2F participants found commonalities in their experiences of living with long COVID. They empathized with one another regarding changing symptoms, inconsistent social support, shifting identities, and barriers to effective medical care.
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Affiliation(s)
- Jessica Barnhill
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Aisha Chilcoat
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Raveena Mata
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Malik Tiedt
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Isabel Roth
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Slotegraaf AI, de Kruif AJTCM, Agasi-Idenburg CS, van Oers SMD, Ronteltap A, Veenhof C, Gerards MHG, Verburg AC, Hoogeboom TJ, de van der Schueren MAE. Understanding recovery of people recovering from COVID-19 receiving treatment from primary care allied health professionals: a mixed-methods study. Disabil Rehabil 2024:1-10. [PMID: 38318773 DOI: 10.1080/09638288.2024.2311330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/24/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To quantitatively assess changes in recovery of people recovering from COVID-19 treated by a primary care allied health professional, and to qualitatively describe how they dealt with persistent complaints. MATERIALS AND METHODS This mixed-methods study is part of a Dutch prospective cohort study, from which thirty participants were selected through purposive sampling. Quantitative data on recovery were collected at start of treatment and 6 months. Additionally, by use of semi-structured interviews participants were asked on how persistent complaints influenced their lives, and how they experienced received primary care allied health treatment. RESULTS Despite reported improvements, most participants still experienced limitations at 6 months. Hospital participants reported a higher severity of complaints, but home participants reported more diverse complaints and a longer recovery. Most participants were satisfied with the primary care allied healthcare. Tender loving care and a listening ear, learning to manage limits, and support and acceptance of building up in small steps were perceived as contributing most to participants' recovery. CONCLUSION Although improvements were reported on almost all outcomes, most participants suffered from persistent complaints. Despite these persistent complaints, many participants reported being better able to cope with persistent complaints because they had decreased substantially in their intensity. TRIAL REGISTRATION Clinicaltrials.gov registry (NCT04735744).
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Affiliation(s)
- Anne I Slotegraaf
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Anja J Th C M de Kruif
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Carla S Agasi-Idenburg
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Sonja M D van Oers
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
| | - Amber Ronteltap
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Cindy Veenhof
- Research Group Innovation of Movement Care, University of Applied Sciences Utrecht, Utrecht, the Netherlands
- Department of Rehabilitation, Physical Therapy Science and Sport, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marissa H G Gerards
- Department of Epidemiology, Care and Public Health Institute (CAPHRI), Faculty of Health, Medicine and Life sciences, Maastricht University, Maastricht, the Netherlands
- Department of Physiotherapy, Maastricht university medical centre, Maastricht, the Netherlands
| | - Arie C Verburg
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, the Netherlands
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20
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Ladds E, Darbyshire JL, Bakerly ND, Falope Z, Tucker-Bell I. Cognitive dysfunction after covid-19. BMJ 2024; 384:e075387. [PMID: 38302141 DOI: 10.1136/bmj-2023-075387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Affiliation(s)
- Emma Ladds
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Julie L Darbyshire
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Nawar Diar Bakerly
- The Northern Care Alliance, Manchester Metropolitan University, University of Manchester
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21
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Hung P, Brehon K, Miciak M, Brown DA, Bostick G, Brown C, Churchill K, Hall M, Hoddinott L, Hudon A, Hunter S, Perreault K, Wieler M, Skolnik K, Lam GY, Weatherald J, Gross DP. "I Had to Know About It, I Had to Find It, I Had to Know How to Access it": Experiences of Access to Rehabilitation Services Among People Living with Long COVID. Physiother Can 2024; 76:8-24. [PMID: 38465303 PMCID: PMC10919370 DOI: 10.3138/ptc-2023-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 03/12/2024]
Abstract
Purpose The aim of this qualitative study is to understand the need for, access to, and quality of rehabilitation services for people living with Long COVID. Little is known about the experiences of people living with Long COVID accessing rehabilitation services. Therefore, we explored health concerns leading people living with Long COVID to seek help to address functional concerns and their experiences with accessing and participating in rehabilitation. Method Interpretive description guided exploration of participants' experiences with Long COVID rehabilitation in Alberta, Canada. Semi-structured interviews were completed with 56 participants recruited from: three publicly funded Long COVID clinics, a specialized private physiotherapy clinic, a telephone-based rehabilitation advice line, and a Workers' Compensation Board-funded Long COVID rehabilitation program. Recruitment through mass media coverage allowed us to include people who did not access rehabilitation services. Data analysis was informed by Braun and Clarke's reflexive thematic analysis. Results Four themes were identified: (1) the burden of searching for guidance to address challenges with functioning and disability; (2) supportive relationships promote engagement in rehabilitation; (3) conditions for participation in safe rehabilitation; and (4) looking forward - provision of appropriate interventions at the right time. Conclusions Our findings highlight the experiences of accessing rehabilitation services for people living with Long COVID. Results suggest approaches to Long COVID rehabilitation should be accessible, multi-disciplinary, flexible, and person-centred.
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Affiliation(s)
- Pam Hung
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Katelyn Brehon
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Maxi Miciak
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Darren A. Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, England, United Kingdom of Great Britain and Northern Ireland
| | - Geoffrey Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Cary Brown
- Department of Occupational Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Katie Churchill
- University Health Network – Rehabilitative Care Alliance, Toronto, Ontario, Canada
| | - Mark Hall
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montreal, Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM), and CIUSSS du Centre-Sud-de-Montréal Quebec, Canada
| | | | - Kadija Perreault
- École des Sciences de la Réadaptation, Faculté de Médecine, Université Laval and Centre for interdisciplinary research in rehabilitation and social integration (Cirris), CIUSSS de la Capitale-Nationale, Quebec, Canada
| | - Marguerite Wieler
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Kate Skolnik
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Grace Y. Lam
- Faculty of Medicine & Dentistry – Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Weatherald
- Faculty of Medicine & Dentistry – Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas P. Gross
- From the:
Rehabilitation Research Centre, University of Alberta, Edmonton, Alberta, Canada
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
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22
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Bilgin A, Kesik G, Ozdemir L. 'The body seems to have no life': The experiences and perceptions of fatigue among patients after COVID-19. J Clin Nurs 2024; 33:126-136. [PMID: 34845774 DOI: 10.1111/jocn.16153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/21/2021] [Accepted: 11/15/2021] [Indexed: 12/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed at determining the perception of fatigue among patients with a history of the coronavirus disease (COVID-19). BACKGROUND Fatigue is a long-lasting distressing symptom. It is a multidimensional symptom consisting of several factors, including physiological, psychological, social and environmental. It is vital to examine and understand the perception of fatigue among post-COVID-19 participants. DESIGN A descriptive phenomenological design. METHODS The study sample consisted of 14 post-COVID-19 participants that were recruited using criterion sampling. The fatigue levels of the participants were determined using the Chalder Fatigue Scale (CFS), and those with a fatigue score above 12 were interviewed. All the interviews were conducted with a smartphone due to the COVID-19. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist was used. RESULTS The age of the participants varied from 24 to 67 years, with the majority of the participants being female (n = 8). The COVID-19 duration ranged from one to 11 months, and the CFS scores varied between 14 and 33. Four themes emerged following the qualitative data analysis: a new symptom beyond fatigue, fatigue increases dependency in daily life, fatigue impedes sociability and a way to hold on to life's regular rhythms. CONCLUSIONS This study concluded that fatigue in post-COVID-19 participants is a new experience that is difficult to define and manage and overwhelmingly affects the physical and social aspects of life. Participants look for new ways to live with fatigue and turn to traditional methods and psychosocial strategies. RELEVANCE TO CLINICAL PRACTICE This study revealed the miscellaneous aspects of fatigue in post-COVID-19 participants. Nurses should evaluate fatigue with a holistic approach that includes its physical, social, emotional and spiritual aspects. Nurses can play an active role in the management of fatigue, which is a very common symptom in the COVID-19 pandemic.
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Affiliation(s)
- Aylin Bilgin
- Nursing Department, Faculty of Health Sciences, Sakarya University of Applied Sciences, Sakarya, Turkey
| | - Gulsah Kesik
- Internal Medicine Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Leyla Ozdemir
- Internal Medicine Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
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23
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Figueiredo B, Sheahan J, Luo S, Bird S, Wong Lit Wan D, Xenos S, Itsiopoulos C, Jessup R, Zheng Z. Journey mapping long COVID: Agency and social support for long-hauling. Soc Sci Med 2024; 340:116485. [PMID: 38056307 DOI: 10.1016/j.socscimed.2023.116485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/23/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Long COVID, also known as Post COVID-19 condition, is defined by the WHO as the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation. Despite many studies examining the causes and mechanisms of this disease, fewer studies have sought to understand the experience of those suffering from long COVID, or "long-haulers," This study contributes to the understanding of long-haulers (N = 14) by examining the role of agency and social support in shaping their journeys with long COVID. Drawing on a combination of interviews, questionnaires, and video diaries over a three-month period, journey mapping was used to document the participants' experiences, including symptoms, coping strategies, and lifestyle changes. Analysis of these journey maps resulted in a framework with four clusters demonstrating the importance of social support and patient agency shaping participants' Long COVID trajectory; the study contributes valuable insights into the daily lives and challenges individuals face with long COVID, informing the development of targeted support programs.
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Affiliation(s)
| | - Jacob Sheahan
- Institute for Design Informatics, University of Edinburgh, United Kingdom.
| | - Shiqi Luo
- School of Health and Biomedical Sciences, RMIT University, Australia.
| | - Stephen Bird
- School of Health and Biostatistics, Swinburne University, Australia.
| | - Dawn Wong Lit Wan
- School of Health and Biomedical Sciences, RMIT University, Australia.
| | - Sophia Xenos
- School of Health and Biomedical Sciences, RMIT University, Australia.
| | | | - Rebecca Jessup
- Staying Well, Northern Hospital, Epping, Victoria, Australia.
| | - Zhen Zheng
- School of Health and Biomedical Sciences, RMIT University, Australia.
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24
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Owen R, Ashton RE, Skipper L, Phillips BE, Yates J, Thomas C, Ferraro F, Bewick T, Haggan K, Faghy MA. Long COVID quality of life and healthcare experiences in the UK: a mixed method online survey. Qual Life Res 2024; 33:133-143. [PMID: 37740144 PMCID: PMC10784347 DOI: 10.1007/s11136-023-03513-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 09/24/2023]
Abstract
PURPOSE The complexity of long COVID and its diverse symptom profile contributes to unprecedented challenges for patients, clinicians, and healthcare services. The threat of long COVID remains ignored by Governments, the media and public health messaging, and patients' experiences must be heard through understanding of the lived experience. This study aimed to understand the lived experience of those living with long COVID. METHODS An online web-based survey was designed using Patient and Public Involvement and Engagement (PPIE) to increase understanding of the lived experiences of long COVID, and was distributed through PPIE groups, social media, and word of mouth. The survey used closed and open questions relating to demographics, pre- and post-COVID-19 health quality of life, daily activities and long COVID experiences. RESULTS Within our sample of 132 people living with long COVID, the findings highlight that individuals are being severely impacted by their symptoms and are unable to or limited in participating in their daily activities, reducing quality of life. Long COVID places strain on relationships, the ability to live life fully and is detrimental to mental health. Varying health care experiences are described by participants, with reports of medical gaslighting and inadequate support received. CONCLUSIONS Long COVID has a severe impact on the ability to live life fully, and strains mental health. The appropriate mechanisms and support services are needed to support those living with long COVID and manage symptoms.
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Affiliation(s)
- Rebecca Owen
- School of Human Sciences, University of Derby, Derby, UK.
| | - Ruth E Ashton
- School of Human Sciences, University of Derby, Derby, UK
| | | | - Bethan E Phillips
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Derby, UK
| | - James Yates
- School of Human Sciences, University of Derby, Derby, UK
| | - Callum Thomas
- School of Human Sciences, University of Derby, Derby, UK
| | | | - Tom Bewick
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Kate Haggan
- Respiratory Medicine, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Mark A Faghy
- School of Human Sciences, University of Derby, Derby, UK
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, Illinois, USA
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25
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Bergmans RS, Chambers-Peeple K, Yu C, Xiao LZ, Wegryn-Jones R, Martin A, Dell'Imperio S, Aboul-Hassan D, Williams DA, Clauw DJ, DeJonckheere M. 'I'm still here, I'm alive and breathing': The experience of Black Americans with long COVID. J Clin Nurs 2024; 33:162-177. [PMID: 37140186 PMCID: PMC10624641 DOI: 10.1111/jocn.16733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 12/05/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
AIMS AND OBJECTIVES In this study, we aimed to characterize the impact of long COVID on quality of life and approaches to symptom management among Black American adults. BACKGROUND As a novel condition, qualitative evidence concerning long COVID symptoms and their impact on quality of life can inform the refinement of diagnostic criteria and care plans. However, the underrepresentation of Black Americans in long COVID research is a barrier to achieving equitable care for all long COVID patients. DESIGN We employed an interpretive description study design. METHODS We recruited a convenience sample of 15 Black American adults with long COVID. We analysed the anonymized transcripts from race-concordant, semi-structured interviews using an inductive, thematic analysis approach. We followed the SRQR reporting guidelines. RESULTS We identified four themes: (1) The impact of long COVID symptoms on personal identity and pre-existing conditions; (2) Self-management strategies for long COVID symptoms; (3) Social determinants of health and symptom management; and (4) Effects on interpersonal relationships. CONCLUSION Findings demonstrate the comprehensive ramifications of long COVID on the lives of Black American adults. Results also articulate how pre-existing conditions, social risk factors, distrust due to systemic racism, and the nature of interpersonal relationships can complicate symptom management. RELEVANCE TO CLINICAL PRACTICE Care approaches that support access to and implementation of integrative therapies may be best suited to meet the needs of long COVID patients. Clinicians should also prioritize eliminating patient exposure to discrimination, implicit bias, and microaggressions. This is of particular concern for long COVID patients who have symptoms that are difficult to objectively quantify, such as pain and fatigue. NO PATIENT OR PUBLIC CONTRIBUTION While patient perspectives and experiences were the focus of this study, patients were not involved with the design or conduct of the study, data analysis or interpretation, or writing the manuscript.
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Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Christine Yu
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian Z Xiao
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Riley Wegryn-Jones
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Allie Martin
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Deena Aboul-Hassan
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - David A Williams
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel J Clauw
- Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
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26
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Zheng X, Qian M, Ye X, Zhang M, Zhan C, Li H, Luo T. Implications for long COVID: A systematic review and meta-aggregation of experience of patients diagnosed with COVID-19. J Clin Nurs 2024; 33:40-57. [PMID: 36253950 PMCID: PMC9874539 DOI: 10.1111/jocn.16537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
AIMS AND OBJECTIVES This review aims to synthesize the available evidence of what patients experience when infected with COVID-19, both in hospital and post-discharge settings. DESIGN This review was conducted using the Joanna Briggs Institute (JBI) methodology for qualitative systematic reviews and evidence synthesis. Reporting of results was presented according to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist. BACKGROUND Coronavirus disease 2019 (COVID-19) continues to be a public health crisis worldwide. Many patients diagnosed with COVID-19 have varied levels of persisting mental disorders. Previous studies have reported the degree, prevalence and outcome of psychological problems. Minimal research explored the experience of patients with long COVID. The real-life experience of patients with COVID-19 from diagnosis to post-discharge can deepen the understanding of nurses, physicians and policymakers. METHODS All studies describing the experience of patients were included. Two authors independently appraised the methodological quality of the included studies using the JBI Critical Appraisal Checklist for Qualitative Research 2020. RESULTS This systematic review aggregated patients' experience of being diagnosed with COVID-19 in both hospitalized and post-discharge settings. Finally, 17 studies met inclusion criteria and quality appraisal guidelines. The selected studies in the meta-synthesis resulted in 12 categories, and further were concluded as five synthesized findings: physical symptoms caused by the virus, positive and negative emotional responses to the virus, positive coping strategies as facilitators of epidemic prevention and control, negative coping strategies as obstacles of epidemic prevention and control, and unmet needs for medical resource. CONCLUSIONS The psychological burden of patients diagnosed with COVID-19 is heavy and persistent. Social support is essential in the control and prevention of the epidemic. Nurses and other staff should pay more attention to the mental health of the infected patients both in and after hospitalization. RELEVANCE TO CLINICAL PRACTICE Nurses should care about the persistent mental trauma of COVID-19 survivors and provide appropriate psychological interventions to mitigate the negative psychological consequences of them. Besides, nurses, as healthcare professionals who may have the most touch with patients, should evaluate the level of social support and deploy it for them. It is also needed for nurses to listen to patient's needs and treat them with carefulness and adequate patience in order to decrease the unmet needs of patients.
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Affiliation(s)
- Xutong Zheng
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Min Qian
- Department of NursingBeijing Ji Shui Tan Hospital and the 4th Medical College of Peking UniversityBeijingChina
| | - Xinxin Ye
- Department of Sports and Exercise ScienceZhejiang UniversityHangzhouChina
- School of Public HealthZhejiang University School of MedicineHangzhouChina
| | - Man Zhang
- School of MedicineYan'an UniversityYan'anChina
| | - Chenju Zhan
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Hui Li
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of NursingMindong Hospital Affiliated to Fujian Medical UniversityNingdeChina
| | - Tiantian Luo
- School of NursingFujian University of Traditional Chinese MedicineFuzhouChina
- Department of Scientific ResearchXiamen Xianyue HospitalXiamenChina
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27
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Foresta A, Ojeda-Fernández L, Augurio C, Guanziroli C, Tettamanti M, Macaluso G, Lauriola P, Nobili A, Roncaglioni MC, Baviera M. Prevalence and Predictors of Post-Acute COVID-19 Symptoms in Italian Primary Care Patients. J Prim Care Community Health 2024; 15:21501319231222364. [PMID: 38166461 PMCID: PMC10768628 DOI: 10.1177/21501319231222364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/04/2024] Open
Abstract
BACKGROUND Despite all the progress in the management of acute COVID-19, it is still not clear why some people continue to experience symptoms after recovery. Using data from a self-administered online survey, we assessed the prevalence and predictors of post-acute COVID-19 in an unselected population followed by GPs. METHODS Patients ≥18 years with a confirmed COVID-19 diagnosis were included. The survey collected information on demographics, risk factors, COVID-19 course and symptomatology. Fatigue and Quality of Life questionnaires were also administered. Descriptive statistics were used to describe patients' characteristics, stratified as acute and post-acute COVID-19. Logistic regression models were used to assess the association between clinical characteristics and post-acute COVID-19. RESULTS A total of 1108 surveys were analyzed. Nearly 29% of patients reported post-acute COVID-19. The more persistent symptoms were fatigue, memory and concentration impairment. Adjusted Odds Ratio (OR) showed a significantly higher probability of post-acute COVID-19 for women compared to men (OR 1.9, 95% CI 1.4-2.5), for age >50 years than ≤50 years (OR 1.6, 95% CI 1.2-2.2), for BMI > 25 compared to BMI ≤ 25 (OR 1.6, 95% CI 1.1-2.1) and those with autoimmune diseases, compared to those without (OR 1.8 95% CI 1.1-2.9). In addition, a significant association was found with COVID-19 hospitalization, anxiety and allergies. We found that post-acute COVID-19 patients showed a higher fatigue and a worst quality of life. CONCLUSIONS These findings suggest the need for tailored personalized strategies to improve the management of patients with post-acute COVID-19.
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Affiliation(s)
- Andreana Foresta
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | | | | | - Mauro Tettamanti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Giulia Macaluso
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Paolo Lauriola
- International Society of Doctors for Environment (ISDE), Rete Italiana Medici Sentinella per l’Ambiente, Geneva, Switzerland
| | | | | | - Marta Baviera
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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28
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Duncan E, Alexander L, Cowie J, Love A, Morris JH, Moss R, Ormerod J, Preston J, Shim J, Stage E, Tooman T, Cooper K. Investigating Scottish Long COVID community rehabilitation service models from the perspectives of people living with Long COVID and healthcare professionals: a qualitative descriptive study. BMJ Open 2023; 13:e078740. [PMID: 38101833 PMCID: PMC10729197 DOI: 10.1136/bmjopen-2023-078740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES This study aimed to explore the perceptions and experiences of barriers and facilitators to accessing Long COVID community rehabilitation. DESIGN We used a qualitative descriptive design over two rounds of data collection with three participant groups: (1) people with experience of rehabilitation for Long COVID (PwLC); (2) National Health Service (NHS) staff delivering and/or managing community rehabilitation services (allied health professionals (AHPs)) and (3) NHS staff involved in strategic planning around Long COVID in their health board (Long COVID leads). SETTING Four NHS Scotland territorial health boards. PARTICIPANTS 51 interviews: eight Long COVID leads (11 interviews); 15 AHPs (25 interviews) and 15 PwLC (15 interviews). RESULTS Three key themes were identified: (1) accessing care for PwLC, (2) understanding Long COVID and its management and (3) strengths and limitations of existing Long COVID rehabilitation services. CONCLUSIONS Organisational delivery of Long COVID community rehabilitation is complex and presents multiple challenges. In addition, access to Long COVID community rehabilitation can be challenging. When accessed, these services are valued by PwLC but require adequate planning, publicity and resource. The findings presented here can be used by those developing and delivering services for people with Long COVID.
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Affiliation(s)
| | - Lyndsay Alexander
- Scottish Centre for Evidence-Based Multi-Professional Practice, Aberdeen, UK
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Julie Cowie
- NMAHP Research Unit, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Rachel Moss
- Healthcare Improvement Scotland, Edinburgh, UK
| | | | - Jenny Preston
- Douglas Grant Rehabilitation Centre, Ayrshire Central Hospital, Irvine, UK
| | - Joanna Shim
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | - Emma Stage
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
| | | | - Kay Cooper
- School of Health Sciences, Robert Gordon University, Aberdeen, UK
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29
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Horlick S, Krysa JA, Brehon K, Pohar Manhas K, Kovacs Burns K, Russell K, Papathanassoglou E, Gross DP, Ho C. Exploring Rehabilitation Provider Experiences of Providing Health Services for People Living with Long COVID in Alberta. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7176. [PMID: 38131727 PMCID: PMC10743286 DOI: 10.3390/ijerph20247176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/10/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND COVID-19 infection can result in persistent symptoms, known as long COVID. Understanding the provider experience of service provision for people with long COVID symptoms is crucial for improving care quality and addressing potential challenges. Currently, there is limited knowledge about the provider experience of long COVID service delivery. AIM To explore the provider experience of delivering health services to people living with long COVID at select primary, rehabilitation, and specialty care sites. DESIGN AND SETTING This study employed qualitative description methodology. Semi-structured interviews were conducted with frontline providers at primary care, rehabilitation, and specialty care sites across Alberta. Participants were interviewed between June and September 2022. METHOD Interviews were conducted virtually over zoom, audio-recorded, and transcribed with consent. Iterative inductive qualitative content analysis of transcripts was employed. Relationships between emergent themes were examined for causality or reciprocity, then clustered into content areas and further abstracted into a priori categories through their interpretive joint meaning. PARTICIPANTS A total of 15 participants across Alberta representing diverse health care disciplines were interviewed. RESULTS Main themes include: the importance of education for long COVID recognition; the role of symptom acknowledgement in patient-centred long COVID service delivery; the need to develop recovery expectations; and opportunities for improvement of navigation and wayfinding to long COVID services. CONCLUSIONS Provider experience of delivering long COVID care can be used to inform patient-centred service delivery for persons with long COVID symptoms.
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Affiliation(s)
- Sidney Horlick
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Jacqueline A. Krysa
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Katelyn Brehon
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada;
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Douglas P. Gross
- Rehabilitation Research Centre, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada; (K.B.); (D.P.G.)
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T6G 2G4, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation and Vision, Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (J.A.K.); (K.P.M.); (K.R.); (E.P.)
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Brehon K, Miciak M, Hung P, Chen SP, Perreault K, Hudon A, Wieler M, Hunter S, Hoddinott L, Hall M, Churchill K, Brown DA, Brown CA, Bostick G, Skolnik K, Lam G, Weatherald J, Gross DP. "None of us are lying": an interpretive description of the search for legitimacy and the journey to access quality health services by individuals living with Long COVID. BMC Health Serv Res 2023; 23:1396. [PMID: 38087299 PMCID: PMC10714615 DOI: 10.1186/s12913-023-10288-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Understanding of Long COVID has advanced through patient-led initiatives. However, research about barriers to accessing Long COVID services is limited. This study aimed to better understand the need for, access to, and quality of, Long COVID services. We explored health needs and experiences of services, including ability of services to address needs. METHODS Our study was informed by the Levesque et al.'s (2013) "conceptual framework of access to health care." We used Interpretive Description, a qualitative approach partly aimed at informing clinical decisions. We recruited participants across five settings. Participants engaged in one-time, semi-structured, virtual interviews. Interviews were transcribed verbatim. We used reflexive thematic analysis. Best practice to ensure methodological rigour was employed. RESULTS Three key themes were generated from 56 interviews. The first theme illustrated the rollercoaster-like nature of participants' Long COVID symptoms and the resulting impact on function and health. The second theme highlighted participants' attempts to access Long COVID services. Guidance received from healthcare professionals and self-advocacy impacted initial access. When navigating Long COVID services within the broader system, participants encountered barriers to access around stigma; appointment logistics; testing and 'normal' results; and financial precarity and affordability of services. The third theme illuminated common factors participants liked and disliked about Long COVID services. We framed each sub-theme as the key lesson (stemming from all likes and dislikes) that, if acted upon, the health system can use to improve the quality of Long COVID services. This provides tangible ways to improve the system based directly on what we heard from participants. CONCLUSION With Long COVID services continuously evolving, our findings can inform decision makers within the health system to better understand the lived experiences of Long COVID and tailor services and policies appropriately.
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Affiliation(s)
| | | | - Pam Hung
- University of Alberta, Edmonton, Canada
| | | | | | - Anne Hudon
- University of Montreal, Montreal, Canada
| | | | | | | | - Mark Hall
- University of Alberta, Edmonton, Canada
| | | | - Darren A Brown
- Chelsea and Westminster Hospital NHS Foundation Trust, London, England, UK
| | | | | | - Kate Skolnik
- Alberta Health Services, Calgary, Canada
- University of Calgary, Calgary, Canada
| | - Grace Lam
- University of Alberta, Edmonton, Canada
- Alberta Health Services, Calgary, Canada
| | - Jason Weatherald
- University of Alberta, Edmonton, Canada
- Alberta Health Services, Calgary, Canada
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Rotar Pavlic D, Maksuti A, Mihevc M, Munda A, Medija K, Strauch V. Long COVID as a never-ending puzzle: the experience of primary care physicians. A qualitative interview study. BJGP Open 2023; 7:BJGPO.2023.0074. [PMID: 37437953 PMCID: PMC11176678 DOI: 10.3399/bjgpo.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Long COVID provides a new context in which primary health care needs to be re-examined, especially because it has health and social dimensions. Primary care physicians' experiences and perceptions of caring for patients with long COVID are an underexplored area. AIM To explore the experiences of Slovenian primary care physicians in management and treatment of patients with long COVID. DESIGN & SETTING A qualitative interview study of physicians in Slovenian primary care. METHOD Semi-structured interviews were held with physicians who had treated patients with long COVID until saturation was reached. The interviews were carried out between November 2021 and April 2022. Qualitative content analysis (QCA) was used to analyse the data collected. RESULTS Seventeen participants were interviewed. The following five categories were defined based on the coding process: the definition and symptoms of long COVID; social exclusion; sick leave and returning to the work environment; cooperation with rehabilitation centres; and the importance of trust and good communication with the patient. CONCLUSION The study showed the experiences of Slovenian primary care physicians in the management and treatment of long COVID. The problems related to long COVID were divided into two groups: health problems and psychosocial problems. Slovenian physicians have the greatest problems with dealing with the patient's ability to work. It was found that adequate communication and trust between physicians and patients are two important indicators for an integrated model of managing long COVID.
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Affiliation(s)
- Danica Rotar Pavlic
- Galenia d.o.o, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Matic Mihevc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Primary Healthcare Research and Development Institute, Health Centre Ljubljana, Ljubljana, Slovenia
| | - Ana Munda
- University Clinical Center Ljubljana, Ljubljana, Slovenia
| | - Karmen Medija
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Viktor Strauch
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Albright C, Limoges J, Rempel GR. Living with pulmonary sequelae of COVID-19 and the implications for clinical nursing practice: A qualitative systematised review. J Clin Nurs 2023; 32:7650-7660. [PMID: 36855220 DOI: 10.1111/jocn.16664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/21/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
AIM To synthesise qualitative research on pulmonary sequelae of COVID-19 and identify patient needs and experiences to develop nursing care strategies. BACKGROUND Qualitative research on long COVID by subtype has not yet occurred. As pulmonary sequelae constitute a serious long COVID subtype, exploring patient experience and needs can generate knowledge to guide nursing practice. DESIGN Systematised review methodology utilised on a purposive sample of published articles and reported using the PRISMA guidelines and checklists. Searched MEDLINE, Cumulative Index to Nursing and Allied Health, and Google Scholar, for English or French articles published from February 2020 to June 2022; qualitative research with adults recovering from COVID-19 with evidence of pulmonary sequelae. METHODS Established principles for data extraction followed related to data reduction, data presentation, data comparison, and conclusion formulation and verification. Analysis was informed by Thorne's Interpretive Description and extended with Meleis' transitions theory, Mishel's uncertainty in illness theory and Moore et al.'s holistic theory of unpleasant symptoms. The quality of included studies was assessed Joanna Briggs Institute critical appraisal tool for qualitative research. RESULTS Four articles with six pooled participants provided data to yield three main themes: (1) a novel health-illness transition, (2) lung injury and pulmonary fibrosis as antecedent to illness uncertainty, (3) and pulmonary symptoms that are compounded by fatigue and weakness. CONCLUSION Pulmonary sequelae of COVID-19 confers a unique health-illness transition, uncertainties and symptoms that can be addressed by theory informed nursing practice. RELEVANCE TO CLINICAL PRACTICE Advocacy, optimising the nurse-patient relationship, offering up-to-date information and addressing uncertainty may help patients cope with pulmonary sequelae, a complex subtype of long COVID with important considerations for clinical nursing care. Despite a lack of evidence-informed clinical pathways, nurses can support patients to understand novel treatments, support discharge planning and acknowledge the synergistic nature of pulmonary symptoms and fatigue to support health-illness transitions. NO PATIENT OR PUBLIC CONTRIBUTION This article involved analysis of previously published works.
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Affiliation(s)
- Cameron Albright
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Jacqueline Limoges
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Gwen R Rempel
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
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Hawke LD, Nguyen ATP, Sheikhan NY, Strudwick G, Rossell SL, Soklaridis S, Kloiber S, Shields R, Ski CF, Thompson DR, Castle D. Swept under the carpet: a qualitative study of patient perspectives on Long COVID, treatments, services, and mental health. BMC Health Serv Res 2023; 23:1088. [PMID: 37821939 PMCID: PMC10568931 DOI: 10.1186/s12913-023-10091-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND A constellation of often disabling long-term physical symptoms enduring after an acute SARS-COV-2 infection is commonly referred to as Long COVID. Since Long COVID is a new clinical entity, research is required to clarify treatment needs and experiences of individuals affected. This qualitative descriptive study aimed to provide insight into Long COVID treatment and service experiences and preferences of individuals experiencing Long COVID and the intersections with mental health. METHODS The study was conducted out of a tertiary care mental health hospital, with online recruitment from the community across Canada. A total of 47 individuals (average age = 44.9) participated in one of 11 focus groups between June and December 2022. Five focus groups were conducted with participants who had pre-existing mental health concerns prior to contracting SARS-CoV-2, and six were with people with Long COVID but without pre-existing mental health concerns. A semi-structured interview guide asked about service experiences and service preferences, including mental health and well-being services. Discussions were recorded, transcribed, and analyzed using codebook thematic analysis. RESULTS When accessing services for Long COVID, patients experienced: (1) systemic barriers to accessing care, and (2) challenges navigating the unknowns of Long COVID, leading to (3) negative impacts on patient emotional well-being and recovery. Participants called for improvements in Long COVID care, with a focus on: (1) developing Long COVID-specific knowledge and services, (2) enhancing support for financial well-being, daily living, and building a Long COVID community, and (3) improving awareness and the public representation of Long COVID. CONCLUSIONS Substantial treatment barriers generate considerable burden for individuals living with Long COVID. There is a pressing need to improve treatment, social supports, and the social representation of Long COVID to create integrated, accessible, responsive, and ongoing support systems.
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Affiliation(s)
- Lisa D Hawke
- University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
| | - Anh T P Nguyen
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Natasha Yasmin Sheikhan
- University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Gillian Strudwick
- University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Sophie Soklaridis
- University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Stefan Kloiber
- University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Roslyn Shields
- Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David Castle
- University of Tasmania, Hobart, Australia
- Tasmanian Centre for Mental Health Service Innovation, Hobart, Australia
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Collier D, Garip G. The hidden pandemic: a qualitative study on how middle-aged women make sense of managing their long COVID symptoms. HEALTH PSYCHOLOGY REPORT 2023; 11:269-281. [PMID: 38178969 PMCID: PMC10762299 DOI: 10.5114/hpr/169811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/31/2023] [Accepted: 07/03/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND A relapsing and remitting illness, long COVID can be challenging and debilitating. A person living with long COVID can feel like they are getting better and recovering only to relapse again. The aim of the research was to explore how non-hospitalized middle-aged women who contracted COVID in the first wave of the pandemic, from March 2020, are managing their long COVID symptoms. PARTICIPANTS AND PROCEDURE A qualitative research study with an interpretative phenomenological analysis approach was used to explore how the women made sense of managing their condition and health seeking behaviours. Participants were recruited from long COVID Facebook groups and semi-structured interviews were conducted remotely by Teams audio; these were digitally recorded and transcribed by hand with prior informed consent. Nine women were interviewed and four themes and eight sub-themes emerged from the data. RESULTS The four emerging themes were: inequality and inconsistent medical treatment; uncertainty and ambiguity of managing long COVID symptoms; managing other people's expectations and perceptions of long COVID; and the changing identity. Overall, these results indicated a general mistrust in health care services to provide adequate support and individualized treatment plans leading women to self-advocacy and to seek alternative support and treatment. CONCLUSIONS This study raised questions about the possible unfair treatment of women seeking medical attention for their long COVID symptoms; how ambiguous symptoms are misattributed to anxiety and discrimination from health care professionals contributes towards stigma. The study concludes with recommendations for service improvement such as the compassionate validation of patients' pain and the use of evidence-based therapeutic practices such as mindfulness.
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Affiliation(s)
- Disa Collier
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
| | - Gulcan Garip
- College of Health, Psychology and Social Care, University of Derby, Derby, United Kingdom
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Duan E, Garry K, Horwitz LI, Weerahandi H. "I Am Not the Same as I Was Before": A Qualitative Analysis of COVID-19 Survivors. Int J Behav Med 2023; 30:663-672. [PMID: 36227557 PMCID: PMC9559269 DOI: 10.1007/s12529-022-10129-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the illness experience of patients' long-term emotional and physical recovery from severe COVID-19 infection. This study aimed to expand upon the recovery process of COVID-19 survivors up to 6 months after hospital discharge. METHODS Qualitative analysis of free-response answers from a cohort study of 152 patients ≥ 18 years hospitalized with laboratory-confirmed SARS-CoV-2 surveyed at 1-month post hospital discharge and 6-months post hospital discharge. Responses were analyzed with a grounded theory approach to identify overarching themes. RESULTS Participants described persistent complications, both physical and mental, that have affected their recovery from COVID-19. Five overarching themes of post-acute patient experiences were generated: (1) an increased awareness of a mind and body connection, (2) feelings of premature aging, (3) an overall decline in quality of life, (4) a continued fear of infection, and (5) methods of coping. CONCLUSIONS Patients described lasting changes to their mental health and overall quality of life in connection to physical complications after severe COVID-19 infection. Patients' reports of their experience call for a greater awareness of the psychological aspects of COVID-19 recovery to provide both physical and psychological rehabilitation services. Additional resources such as education around re-infection and financial resources are needed.
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Affiliation(s)
- Emily Duan
- NYU Grossman School of Medicine, New York, NY, USA
| | - Kira Garry
- University Park Program, Pennsylvania State College of Medicine, State College, Hershey, PA, USA
| | - Leora I Horwitz
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA
| | - Himali Weerahandi
- Division of Healthcare Delivery Science, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
- Center for Healthcare Innovation and Delivery Science, NYU Langone Health, New York, NY, USA.
- Division of General Internal Medicine and Clinical Innovation, Department of Medicine, NYU Grossman School of Medicine, 227 East 30th St., NY, 10016, New York, USA.
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Al‐Jabr H, Thompson DR, Castle DJ, Ski CF. Experiences of people with long COVID: Symptoms, support strategies and the Long COVID Optimal Health Programme (LC-OHP). Health Expect 2023; 27:e13879. [PMID: 37751413 PMCID: PMC10726154 DOI: 10.1111/hex.13879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION Long COVID (LC) is a multisystem illness, with fluctuating symptoms that affect the daily activities of patients. There are still no standardised diagnostic criteria or treatment approaches for managing LC. The LC-Optimal Health Programme (LC-OHP) was designed to support the mental wellbeing and physical health of people with LC. Gaining an in-depth understanding of patients' experiences and support strategies is imperative to identifying appropriate supports to guide them through their recovery. This study aimed to elicit the experiences and perceptions of adults with LC regarding symptoms, support strategies and the LC-OHP. METHODS As part of a wider randomised controlled trial of the LC-OHP, participants in the intervention group had their sessions audio-recorded. Transcripts were thematically analysed to identify common emergent themes. FINDINGS The LC-OHP was delivered to 26 participants. Data were collected between January 2022 and February 2023. Four main themes emerged: 'Symptoms and impact of LC'; 'Other sources of support and perceived challenges'; 'Strategies to support LC' and 'Perceptions of the LC-OHP'. CONCLUSION LC experiences were mostly described as fluctuating and burdensome that significantly impacted daily activities, and physical and mental health. The LC-OHP was perceived as beneficial. Access and experiences of other sources of support were varied. Increasing LC awareness amongst health practitioners and the wider community has the potential to improve the experiences of those affected by LC. PATIENT OR PUBLIC CONTRIBUTION The LC-OHP was derived from the OHP. It was adapted to people with LC following consultation with practitioners at an LC clinic. Additionally, the mode and timing of delivering the programme to this population were taken into account for its delivery at the convenience of participating patients. While considering that fatigue and brain fog are amongst the most reported complaints of people with LC, public members with LC were not involved directly in this study; however, feedback obtained from practitioners working with this population was implemented in amending the programme and its delivery. Additionally, feedback from patients with other chronic health conditions who used the OHP in previous studies has been implemented to make the programme more user-friendly. Moreover, feedback obtained from participants receiving this programme in this study was implanted immediately and shared with other participants. Finally, this study was overviewed by a data management committee that included two public members with LC, who contributed and provided guidance to support this study.
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Affiliation(s)
- Hiyam Al‐Jabr
- Primary Community and Social CareFaculty of Medicine and Health SciencesUniversity of KeeleKeeleUK
| | | | - David J. Castle
- Department of PsychiatryUniversity of TasmaniaHobartTasmaniaAustralia
- Centre for Mental Health Service InnovationHobartTasmaniaAustralia
| | - Chantal F. Ski
- School of Nursing and MidwiferyQueen's University BelfastBelfastUK
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Meyerson WU, Hoyle RH. Pre-pandemic activity on a myalgic encephalomyelitis/chronic fatigue syndrome support forum is highly associated with later activity on a long COVID support forum for a variety of reasons: A mixed methods study. PLoS One 2023; 18:e0291173. [PMID: 37682908 PMCID: PMC10490974 DOI: 10.1371/journal.pone.0291173] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/31/2023] [Indexed: 09/10/2023] Open
Abstract
Encephalomyelitis/chronic fatigue syndrome (ME/CFS) and long COVID share some clinical and social characteristics. We predicted that this would lead to an increased interaction between pre-pandemic members of an ME/CFS online support community and a long COVID community. We performed a mixed-methods retrospective observational study of the Reddit activity of 7,544 users active on Reddit's long COVID forum. From among 1600 forums, pre-pandemic activity specifically on a ME/CFS forum is the top predictor of later participation on the long COVID forum versus an acute COVID support forum. In the qualitative portion, motives for this co-participation included seeking mutual support and dual identification with both conditions. Some of this effect may be explained by pre-existing ME/CFS possibly being a risk factor for long COVID and/or SARS-CoV-2 infection being a cause of ME/CFS relapse. The high rate of ME/CFS patients seeking mutual support on a long COVID forum speaks to the long-suffering experience of these patients not feeling heard or respected, and the hope of some ME/CFS patients to gain legitimacy through the public's growing recognition of long COVID.
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Affiliation(s)
- William U. Meyerson
- Department of Psychiatry & Behavioral Sciences, Duke University Health System, Durham, North Carolina, United States of America
| | - Rick H. Hoyle
- Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, United States of America
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Buonsenso D, Camporesi A, Morello R, De Rose C, Fracasso M, Chieffo DPR, Valentini P. Social Stigma in Children with Long COVID. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1518. [PMID: 37761479 PMCID: PMC10529184 DOI: 10.3390/children10091518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
There is growing evidence that adults with Long COVID suffer from different sets of stigmata related to their condition. In children with Long COVID, this aspect has never been investigated. This study aims to investigate if children with Long COVID also experience stigma. METHODS Children with a previous SARS-CoV-2 infection evaluated at 3 month follow-ups in a pediatric post COVID unit were asked to fill in an online Long COVID Stigma Scale survey before they were assessed by a pediatrician. Doctors were unaware of children's responses when they performed a diagnosis of Long COVID or full recovery from previous infection, according to the World Health Organization definition of pediatric Long COVID. Responses to the Stigma scale were then compared in the two cohorts of children. RESULTS 224 patients responded to the questionnaire; 40 patients were diagnosed with Long COVID. Children with Long COVID significantly more frequently felt embarrassed about having Long COVID (p 0.035), felt embarrassed about having physical limitations (p < 0.001), felt they were valued less due to Long COVID (p 0.003), felt they were different from other peers due to Long COVID (p 0.033), felt significantly more frequently that people behaved differently towards them because they might be lying since the diagnosis of Long COVID (p 0.006), that they were less respected by others due to Long COVID (p 0.017), that other people thought that Long COVID is not a real disease (p 0.007), that other people thought that developing Long COVID is a sign of weakness (p 0.008), and that other people might judge them negatively due to their diagnosis of Long COVID (p < 0.001). CONCLUSIONS Children with Long COVID, similar to adults, are suffering from stigmata due to their condition,. These data may have implication and should be used by the public, policy makers, and healthcare professionals regarding pediatric Long COVID.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
- Center for Global Health Research Studies, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Anna Camporesi
- Pediatric Anesthesia and Intensive Care Unit, “Vittore Buzzi” Children’s Hospital, 20154 Milan, Italy;
| | - Rosa Morello
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Cristina De Rose
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
| | - Matteo Fracasso
- Medicine and Surgery, Universityà Cattolica del Sacro Cuore, 00168 Roma, Italy;
| | - Daniela Pia Rosaria Chieffo
- Clinical Psychology Unit, Fondazione Policlinico Universitario A Gemelli IRCCS, 00168 Rome, Italy;
- Department of Woman, Children and Public Health, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (R.M.); (C.D.R.); (P.V.)
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Pirro M, Ferri L, Piccioni L, Bellucci AM, Bartolucci F, Russo A, Piga A, Ciaramaglia PL, Lucangeli M, Russo AM, Cuzzocrea S, Evangelista M. What Is the Role of Palmitoylethanolamide Co-Ultramicronized with Luteolin on the Symptomatology Reported by Patients Suffering from Long COVID? A Retrospective Analysis Performed by a Group of General Practitioners in a Real-Life Setting. Nutrients 2023; 15:3701. [PMID: 37686733 PMCID: PMC10490268 DOI: 10.3390/nu15173701] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
Long COVID is a recognized post-viral syndrome characterized by neurological, somatic and neuropsychiatric symptoms that might last for long time after SARS-CoV-2 infection. An ever-growing number of patients come to the observation of General Practitioners complaining of mild or moderate symptoms after the resolution of the acute infection. Nine General Practitioners from the Rome area (Italy) performed a retrospective analysis in order to evaluate the role of the supplementation with Palmitoylethanolamide co-ultramicronized with Luteolin (PEALUT) on neurologic and clinical symptoms reported by their patients after COVID-19 resolution. Supplementation with PEALUT helped to improve all patient-reported symptoms, especially pain, anxiety and depression, fatigue, brain fog, anosmia and dysgeusia, leading to an overall improvement in patients' health status. To our knowledge these are the first data presented on Long COVID patients collected in a territorial setting. Despite their preliminary nature, these results highlight the pathogenetic role of "non-resolving" neuroinflammation in Long COVID development and consequently the importance of its control in the resolution of the pathology and put the focus on the General Practitioner as the primary figure for early detection and management of Long COVID syndrome in a real-life setting. Future randomized, controlled, perspective clinical trials are needed to confirm this preliminary observation.
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Affiliation(s)
- Maurizio Pirro
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Luana Ferri
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Licia Piccioni
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Anna Maria Bellucci
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Federica Bartolucci
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Arianna Russo
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Andrea Piga
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | | | - Marco Lucangeli
- Azienda Sanitaria Locale (ASL), Sistema Sanitario Regionale, 00012 Rome, Italy
| | - Anna Maria Russo
- Institute of Anaesthesiology and Reanimation, Catholic University of Sacred Heart, 00168 Rome, Italy
| | - Salvatore Cuzzocrea
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
| | - Maurizio Evangelista
- Institute of Anaesthesiology and Reanimation, Catholic University of Sacred Heart, 00168 Rome, Italy
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, 98166 Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98166 Messina, Italy
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Krysa JA, Horlick S, Pohar Manhas K, Kovacs Burns K, Buell M, Santana MJ, Russell K, Papathanassoglou E, Ho C. Accessing Care Services for Long COVID Sufferers in Alberta, Canada: A Random, Cross-Sectional Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6457. [PMID: 37569003 PMCID: PMC10419146 DOI: 10.3390/ijerph20156457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Designing appropriate rehabilitation programs for long COVID-19 remains challenging. The purpose of this study was to explore the patient experience of accessing long COVID-19 rehabilitation and recovery services. In this cross-sectional, observational study, a telephone survey was administered to a random sample of persons with long COVID-19 in a Canadian province. Participants included adults who tested positive for COVID-19 between March and October 2021. Survey respondents (n = 330) included individuals who had been previously hospitalized for COVID-19 (n = 165) and those who had not been hospitalized ('non-hospitalized') for COVID-19 (n = 165). Significantly more previously hospitalized respondents visited a family doctor for long COVID-19 symptoms compared to non-hospitalized respondents (hospitalized: n = 109 (66.1%); non-hospitalized: n = 25 (15.2%); (p < 0.0001)). Previously hospitalized respondents reported significantly more referrals to specialty healthcare providers for long COVID-19 sym`ptoms (hospitalized: n = 45 (27.3%); non-hospitalized: n = 6 (3.6%); (p < 0.001)). A comparable number of respondents in both groups accessed care services that did not require a referral to manage their long COVID-19 symptoms (hospitalized: n = 31 (18.8%); non-hospitalized: n = 20 (12.1%); (p = 0.20)). These findings demonstrate the diversity of recovery services used by individuals with long COVID-19 and emphasize the need for multidisciplinary long COVID-19 rehabilitation and recovery care pathways.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
| | - Sidney Horlick
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Katharina Kovacs Burns
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
- Department of Clinical Quality Metrics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
| | - Mikayla Buell
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Maria J. Santana
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Kristine Russell
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Faculty of Nursing, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Chester Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB T5J 3E4, Canada (M.B.); (K.R.)
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2E1, Canada
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Mclaughlin M, Cerexhe L, Macdonald E, Ingram J, Sanal-Hayes NEM, Hayes LD, Meach R, Carless D, Sculthorpe N. A Cross-Sectional Study of Symptom Prevalence, Frequency, Severity, and Impact of Long COVID in Scotland: Part II. Am J Med 2023:S0002-9343(23)00461-8. [PMID: 37478960 DOI: 10.1016/j.amjmed.2023.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/15/2023] [Accepted: 07/05/2023] [Indexed: 07/23/2023]
Abstract
BACKGROUND There has been some effort to map the prevalence, frequency, and severity of symptoms of long COVID at local and national levels. However, what is frequently absent from such accounts is details of the impact the disease and its symptoms have had on those living with the condition. In this article, we present details of the impact on work, caring, and mental health gathered using a cross-sectional survey. METHODS Data were collected using an online survey that was available from April 21, 2022, to August 5, 2022. Included participants had either self-diagnosed or confirmed long COVID, were living in Scotland, and were aged ≥18 years. Hospitalization during initial COVID-19 infection was an exclusion criterion. Participants were asked to report on the impact of their illness on everyday activities such as working, studying, or caring. They also completed an assessment of their current mood. RESULTS People with long COVID were often severely impacted in their ability to work and study. Severe impact on work and study were predicted by more severe and more frequent fatigue, more severe pain, and more severe cognitive impairment. Respondents' ability to care for child dependents was also associated with more severe and more frequent fatigue, and more severe cognitive impairments. More severe pain associated with greater impact on adult care. Negative mood correlated most strongly with frequency and severity of neurological symptoms, including lack of attention, loss of smell, impaired sense of smell, loss of taste, impaired sense of taste, and loss of appetite. CONCLUSIONS Long COVID has a significant impact on ability to work, study, and care for dependents. The severity of this impact is associated with specific symptom burden, including fatigue, pain, and cognitive impairment.
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Affiliation(s)
- Marie Mclaughlin
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom.
| | - Luke Cerexhe
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Eilidh Macdonald
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Joanne Ingram
- School of Education and Social Sciences, University of the West of Scotland, Paisley, United Kingdom
| | - Nilihan E M Sanal-Hayes
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom; School of Health and Society, University of Salford, Salford, United Kingdom
| | - Lawrence D Hayes
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Rachel Meach
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - David Carless
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
| | - Nicholas Sculthorpe
- Sport and Physical Activity Research Institute, School of Health and Life Sciences, University of the West of Scotland, Glasgow, United Kingdom
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Alwan NA, Clutterbuck D, Pantelic M, Hayer J, Fisher L, Hishmeh L, Heightman M, Allsopp G, Wootton D, Khan A, Hastie C, Jackson M, Rayner C, Brown D, Parrett E, Jones G, Smith K, Clarke R, Mcfarland S, Gabbay M, Banerjee A. Long Covid active case finding study protocol: A co-produced community-based pilot within the STIMULATE-ICP study (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways). PLoS One 2023; 18:e0284297. [PMID: 37471432 PMCID: PMC10358953 DOI: 10.1371/journal.pone.0284297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 03/28/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND AND AIM Long Covid is a significant public health concern with potentially negative implications for health inequalities. We know that those who are already socially disadvantaged in society are more exposed to COVID-19, experience the worst health outcomes and are more likely to suffer economically. We also know that these groups are more likely to experience stigma and have negative healthcare experiences even before the pandemic. However, little is known about disadvantaged groups' experiences of Long Covid, and preliminary evidence suggests they may be under-represented in those who access formal care. We will conduct a pilot study in a defined geographical area in London, United Kingdom to test the feasibility of a community-based approach of identifying Long Covid cases that have not been clinically diagnosed and have not been referred to Long Covid specialist services. We will explore the barriers to accessing recognition, care, and support, as well as experiences of stigma and perceived discrimination. METHODS This protocol and study materials were co-produced with a Community Advisory Board (CAB) made up primarily of people living with Long Covid. Working with voluntary organisations, a study leaflet will be distributed in the local community to highlight Long Covid symptoms and invite those experiencing them to participate in the study if they are not formally diagnosed. Potential participants will be assessed according to the study's inclusion criteria and offered the opportunity to participate if they fit them. Awareness of Long Covid and associated symptoms, experiences of trying to access care, as well as stigma and discrimination will be explored through qualitative interviews with participants. Upon completion of the interviews, participants will be offered a referral to the local social prescribing team to receive support that is personalised to them potentially including, but not restricted to, liaising with their primary care provider and the regional Long Covid clinic.
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Affiliation(s)
- Nisreen A. Alwan
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | - Donna Clutterbuck
- School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, United Kingdom
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Jasmine Hayer
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Lere Fisher
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Lyth Hishmeh
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Melissa Heightman
- University College London Hospitals NHS Trust, London, United Kingdom
| | - Gail Allsopp
- Royal College of General Practitioners, London, United Kingdom
| | - Dan Wootton
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Asad Khan
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Claire Hastie
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Long Covid Support Charity, https://www.longcovid.org/, London, United Kingdom
| | - Monique Jackson
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Clare Rayner
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Darren Brown
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
- Long COVID Physio, https://longcovid.physio/, London, United Kingdom
| | - Emily Parrett
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Geraint Jones
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Kerry Smith
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Rowan Clarke
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
| | - Sammie Mcfarland
- Community Advisory Board (as person with lived experience of Long Covid), STIMULATE-ICP, London, United Kingdom
- Long Covid Kids Charity, https://www.longcovidkids.org/, Salisbury, United Kingdom
| | - Mark Gabbay
- NIHR Applied Research Collaboration North West Coast, Liverpool, United Kingdom
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, United Kingdom
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, United Kingdom
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Kennedy J, Parker M, Seaborne M, Mhereeg M, Walker A, Walker V, Denaxas S, Kennedy N, Katikireddi SV, Brophy S. Healthcare use attributable to COVID-19: a propensity-matched national electronic health records cohort study of 249,390 people in Wales, UK. BMC Med 2023; 21:259. [PMID: 37468884 PMCID: PMC10354936 DOI: 10.1186/s12916-023-02897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/10/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND To determine the extent and nature of changes associated with COVID-19 infection in terms of healthcare utilisation, this study observed healthcare contact 1 to 4 and 5 to 24 weeks following a COVID-19 diagnosis compared to propensity-matched controls. METHODS Two hundred forty nine thousand three hundred ninety Welsh individuals with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were identified from data from national PCR test results. After elimination criteria, 98,600 positive individuals were matched to test negative and never tested controls using propensity matching. Cohorts were split on test location. Tests could be taken in either the hospital or community. Controls were those who had tested negative in their respective environments. Survival analysis was utilised for first clinical outcomes which are grouped into primary and secondary. Primary outcomes include post-viral-illness and fatigue as an indication of long-COVID. Secondary outcomes include clinical terminology concepts for embolism, respiratory conditions, mental health conditions, fit notes, or hospital attendance. Increased instantaneous risk for positive individuals was quantified using hazard ratios (HR) from Cox regression, while absolute risk (AR) and relative risk were quantified using life table analysis. RESULTS Analysis was conducted using all individuals and stratified by test location. Cases are compared to controls from the same test location. Fatigue (HR: 1.77, 95% CI: 1.34-2.25, p = < 0.001) and embolism (HR: 1.50, 95% CI: 1.15-1.97, p = 0.003) were more likely to occur in all positive individuals in the first 4 weeks; however, anxiety and depression (HR: 0.83, 95% CI: 0.73-0.95, p = 0.007) were less likely. Positive individuals continued to be more at risk of fatigue (HR: 1.47, 95% CI: 1.24-1.75, p = < 0.001) and embolism (HR: 1.51, 95% CI: 1.13-2.02, p = 0.005) after 4 weeks. All positive individuals are also at greater risk of post-viral illness (HR: 4.57, 95% CI: 1.77-11.80, p = 0.002). Despite statistical association between testing positive and several conditions, life table analysis shows that only a small minority of the study population were affected. CONCLUSIONS Community COVID-19 disease is associated with increased risks of post-viral-illness, fatigue, embolism, and respiratory conditions. Despite elevated risks, the absolute healthcare burden is low. Subsequently, either very small proportions of people experience adverse outcomes following COVID-19 or they are not presenting to healthcare.
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Affiliation(s)
- J Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Parker
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK.
| | - M Seaborne
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - M Mhereeg
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - A Walker
- Datalab, Nuffield Dept of Primary Care Health Science, Radcliffe Primary Care Building, Oxford, OX2 6GG, UK
| | - V Walker
- Bristol Medical School: Population Health Sciences, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - S Denaxas
- Institute for Health Informatics, UCL, London, UK
| | - N Kennedy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
| | - S V Katikireddi
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - S Brophy
- National Centre for Population Health and Wellbeing Research, Swansea University Medical School, Swansea, Wales, UK
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Lo T, MacMillan A, Oudit GY, Usman H, Cabaj JL, MacDonald J, Saini V, Sikdar KC. Long-term health care use and diagnosis after hospitalization for COVID-19: a retrospective matched cohort study. CMAJ Open 2023; 11:E706-E715. [PMID: 37582621 PMCID: PMC10435242 DOI: 10.9778/cmajo.20220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Knowledge pertaining to the health and health care utilization of patients after recovery from acute COVID-19 is limited. We sought to assess the frequency of new diagnoses of disease and health care use after hospitalization with COVID-19. METHODS We included all patients hospitalized with COVID-19 in Alberta between Mar. 5 and Dec. 31, 2020. Additionally, 2 matched controls (SARS-CoV-2 negative) per case were included and followed up until Apr. 30, 2021. New diagnoses and health care use were identified from linked administrative health data. Repeated measures were made for the periods 1-30 days, 31-60 days, 61-90 days, 91-180 days, and 180 and more days from the index date. We used multivariable regression analysis to evaluate the association of COVID-19-related hospitalization with the number of physician visits during follow-up. RESULTS The study sample included 3397 cases and 6658 controls. Within the first 30 days of follow-up, the case group had 37.12% (95% confidence interval [CI] 35.44% to 38.80%) more patients with physician visits, 11.12% (95% CI 9.77% to 12.46%) more patients with emergency department visits and 2.92% (95% CI 2.08% to 3.76%) more patients with hospital admissions than the control group. New diagnoses involving multiple organ systems were more common in the case group. Regression results indicated that recovering from COVID-19-related hospitalization, admission to an intensive care unit, older age, greater number of comorbidities and more prior health care use were associated with increased physician visits. INTERPRETATION Patients recovered from the acute phase of COVID-19 continued to have greater health care use up to 6 months after hospital discharge. Research is required to further explore the effect of post-COVID-19 conditions, pre-existing health conditions and health-seeking behaviours on health care use.
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Affiliation(s)
- Tkt Lo
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta.
| | - Andrew MacMillan
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Gavin Y Oudit
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Hussain Usman
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Jason L Cabaj
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Judy MacDonald
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Vineet Saini
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Khokan C Sikdar
- Provincial Population and Public Health (Lo, MacMillan, Usman, Cabaj, MacDonald, Saini, Sikdar), Alberta Health Services, Calgary, Alta.; Mazankowski Alberta Heart Institute (Oudit) and Division of Cardiology (Oudit), Department of Medicine, University of Alberta, Edmonton, Alta.; Department of Community Health Sciences (Cabaj, MacDonald, Saini, Sikdar), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Houchen-Wolloff L, Overton C, Ibbetson A, Walters A, Hastie C, Gill R, Armstrong N, Singh S, Little P, Evans K, Pimm J, Marks M, Poinasamy K, Walker S, Briggs A, Evans RA. A typology of healthcare pathways after hospital discharge for adults with COVID-19: the evolution of UK services during pandemic conditions. ERJ Open Res 2023; 9:00565-2022. [PMID: 37583962 PMCID: PMC10423987 DOI: 10.1183/23120541.00565-2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/30/2023] [Indexed: 08/17/2023] Open
Abstract
Introduction Over half of post-COVID-hospitalisation adults have persistent symptoms 2 years after discharge, providing a challenge for individuals and healthcare systems. We therefore aimed to describe a typology of UK healthcare pathways post-hospital discharge as a first step towards understanding clinical effectiveness and cost-effectiveness of different healthcare pathways. Methods In 2021, we surveyed hospital sites taking part in the UK Post-hospital COVID-19 (PHOSP-COVID) study. The online survey explored the availability of proactive follow-up, patient selection, involvement of multidisciplinary teams, investigations, assessment and access to mental health and rehabilitation interventions. The typology was defined by a three-stage process: 1) using the survey results to develop a bespoke algorithm to inform a draft classification, 2) a stakeholder event for refinement and 3) finalisation between the Project Advisory Group and research team. The bespoke algorithm was used to map each site onto the classification with further mapping by level of mental health and rehabilitation provision. Results 70% of hospital sites (45 out of 64) responded to the survey. 82% (37 out of 45) reported delivering a follow-up service after hospital discharge during the first few months of the pandemic. Only 13 out of 37 services (35%) were delivered by permanent staff. The final typology of five categories included no proactive follow-up, and a matrix of four groups based on patient selection (prespecified subgroup/all patients) and complexity of assessment (low/high). The complexity of assessment, rehabilitation and mental health interventions was variable within sites. Discussion We describe the first typology of post-hospitalisation COVID-19 healthcare pathways to enable modelling of clinical effectiveness and cost-effectiveness to inform future policy. Our results highlight the heterogeneity and vulnerability of healthcare services after COVID-19 hospitalisation.
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Affiliation(s)
- Linzy Houchen-Wolloff
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Charlotte Overton
- SAPPHIRE, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Andrew Ibbetson
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Archie Walters
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Rhyan Gill
- Leicester NIHR Biomedical Research Centre- Respiratory Patient and Public Involvement Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Natalie Armstrong
- SAPPHIRE, Department of Population Health Sciences, College of Life Sciences, University of Leicester, Leicester, UK
| | - Sally Singh
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Paul Little
- Department of Medicine, University of Southampton, Southampton, UK
| | - Kirby Evans
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - John Pimm
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Michael Marks
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Hospital for Tropical Diseases, University College Hospital London, London, UK
- Division of Infection and Immunity, University College London, London, UK
| | | | | | - Andrew Briggs
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Rachael A. Evans
- Leicester NIHR Biomedical Research Centre – Respiratory, University Hospitals of Leicester NHS Trust, Leicester, UK
- Department of Respiratory Sciences, University of Leicester, Leicester, UK
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Manganotti P, Michelutti M, Furlanis G, Deodato M, Buoite Stella A. Deficient GABABergic and glutamatergic excitability in the motor cortex of patients with long-COVID and cognitive impairment. Clin Neurophysiol 2023; 151:83-91. [PMID: 37210757 PMCID: PMC10170904 DOI: 10.1016/j.clinph.2023.04.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 04/20/2023] [Accepted: 04/27/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Attention, working memory and executive processing have been reported to be consistently impaired in Neuro-Long coronavirus disease (COVID). On the hypothesis of abnormal cortical excitability, we investigated the functional state of inhibitory and excitatory cortical regulatory circuits by single "paired-pulse" transcranial magnetic stimulation (ppTMS) and Short-latency Afferent Inhibition (SAI). METHODS We compared clinical and neurophysiological data of 18 Long COVID patients complaining of persistent cognitive impairment with 16 Healthy control (HC) subjects. Cognitive status was evaluated by means of the Montreal Cognitive Assessment (MoCA) and a neuropsychological evaluation of the executive function domain; fatigue was scored by the Fatigue Severity Scale (FSS). Resting motor threshold (RMT), the amplitude of the motor evoked potential (MEP), Short Intra-cortical Inhibition (SICI), Intra-cortical Facilitation (ICF), Long-interval Intracortical Inhibition (LICI) and Short-afferent inhibition (SAI) were investigated over the motor (M1) cortex. RESULTS MoCA corrected scores were significantly different between the two groups (p = 0.023). The majority of the patients' performed sub-optimally in the neuropsychological assessment of the executive functions. The majority (77.80%) of the patients reported high levels of perceived fatigue in the FSS. RMT, MEPs, SICI and SAI were not significantly different between the two groups. On the other hand, Long COVID patients showed a reduced amount of inhibition in LICI (p = 0.003) and a significant reduction in ICF (p < 0.001). CONCLUSIONS Neuro-Long COVID patients performing sub-optimally in the executive functions showed a reduction of LICI related to GABAb inhibition and a reduction of ICF related to glutamatergic regulation. No alteration in cholinergic circuits was found. SIGNIFICANCE These findings can help to better understand the neurophysiological characteristics of Neuro-Long COVID, and in particular, motor cortex regulation in people with "brain fog".
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Affiliation(s)
- Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy.
| | - Marco Michelutti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Giovanni Furlanis
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Manuela Deodato
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
| | - Alex Buoite Stella
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste - ASUGI, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy
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Woodrow M, Carey C, Ziauddeen N, Thomas R, Akrami A, Lutje V, Greenwood DC, Alwan NA. Systematic Review of the Prevalence of Long COVID. Open Forum Infect Dis 2023; 10:ofad233. [PMID: 37404951 PMCID: PMC10316694 DOI: 10.1093/ofid/ofad233] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/28/2023] [Indexed: 07/06/2023] Open
Abstract
Background Long COVID occurs in those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) whose symptoms persist or develop beyond the acute phase. We conducted a systematic review to determine the prevalence of persistent symptoms, functional disability, or pathological changes in adults or children at least 12 weeks postinfection. Methods We searched key registers and databases from January 1, 2020 to November 2, 2021, limited to publications in English and studies with at least 100 participants. Studies in which all participants were critically ill were excluded. Long COVID was extracted as prevalence of at least 1 symptom or pathology, or prevalence of the most common symptom or pathology, at 12 weeks or later. Heterogeneity was quantified in absolute terms and as a proportion of total variation and explored across predefined subgroups (PROSPERO ID CRD42020218351). Results One hundred twenty studies in 130 publications were included. Length of follow-up varied between 12 weeks and 12 months. Few studies had low risk of bias. All complete and subgroup analyses except 1 had I2 ≥90%, with prevalence of persistent symptoms range of 0%-93% (pooled estimate [PE], 42.1%; 95% prediction interval [PI], 6.8% to 87.9%). Studies using routine healthcare records tended to report lower prevalence (PE, 13.6%; PI, 1.2% to 68%) of persistent symptoms/pathology than self-report (PE, 43.9%; PI, 8.2% to 87.2%). However, studies systematically investigating pathology in all participants at follow up tended to report the highest estimates of all 3 (PE, 51.7%; PI, 12.3% to 89.1%). Studies of hospitalized cases had generally higher estimates than community-based studies. Conclusions The way in which Long COVID is defined and measured affects prevalence estimation. Given the widespread nature of SARS-CoV-2 infection globally, the burden of chronic illness is likely to be substantial even using the most conservative estimates.
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Affiliation(s)
- Mirembe Woodrow
- Correspondence: N. A. Alwan, PhD, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK (); M. Woodrow, MSc, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK ()
| | - Charles Carey
- Manchester University NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | - Nida Ziauddeen
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
- NIHR Applied Research Collaboration Wessex, Southampton, United Kingdom
| | | | - Athena Akrami
- Sainsbury Wellcome Centre, University College London, London, United Kingdom
- Patient-led Research Collaborative, Washington, District of Columbia, USA
| | - Vittoria Lutje
- Cochrane Infectious Diseases Group, Liverpool, United Kingdom
| | | | - Nisreen A Alwan
- Correspondence: N. A. Alwan, PhD, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK (); M. Woodrow, MSc, School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK ()
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48
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Al-Jabr H, Hawke LD, Thompson DR, Clifton A, Shenton M, Castle DJ, Ski CF. Interventions to support mental health in people with long COVID: a scoping review. BMC Public Health 2023; 23:1186. [PMID: 37340400 DOI: 10.1186/s12889-023-16079-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Long COVID (LC) is a multisystem disease with symptoms lasting weeks or months beyond the acute COVID-19 infection. Several manifestations are reported by people with LC, including effects on mental health, with varying degrees of psychological distress and disturbances to daily activities. Research conducted to identify effective interventions to support mental health among people with LC has been limited by the breadth and scope of studies. AIM This review aims to identify interventions being tested to support mental health of people with LC. METHODS A scoping review was conducted by searching five databases for articles published between January 2020 and early October 2022 to identify research evaluating interventions focused on improving mental health symptoms associated with LC. Results from all sources were checked for eligibility by two reviewers, and agreements were resolved by discussion. Gray literature and reference list of included studies and relevant reviews were scrutinised to identify any additional studies. Data extraction was conducted by one reviewer and checked by another reviewer for accuracy. RESULTS Of the 940 studies identified, 17 were included, the design of which varied but included mainly case studies (n = 6) and clinical trials (n = 5). Several interventions were described, ranging from single interventions (e.g., pharmacologic) to more holistic, comprehensive suites of services (pharmacologic and non-pharmacologic). Several mental health outcomes were measured, mostly anxiety and depression. All included studies were reported to be associated with improvements in participants' mental health outcomes. CONCLUSION This scoping review identified studies reporting on a variety of interventions to support mental health among people with LC. Although positive changes were reported by all studies, some were case studies and thus their findings must be interpreted with caution. There is a need for more research to be conducted to identify the impact of interventions on mental health of people with LC.
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Affiliation(s)
- Hiyam Al-Jabr
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Canada
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Andrew Clifton
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - Mark Shenton
- Integrated Care Academy, University of Suffolk, Ipswich, UK
| | - David J Castle
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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49
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Wang C, Ramasamy A, Verduzco-Gutierrez M, Brode WM, Melamed E. Acute and post-acute sequelae of SARS-CoV-2 infection: a review of risk factors and social determinants. Virol J 2023; 20:124. [PMID: 37328773 PMCID: PMC10276420 DOI: 10.1186/s12985-023-02061-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 06/18/2023] Open
Abstract
SARS-CoV-2 infection leading to Coronavirus Disease 2019 (COVID-19) has caused more than 762 million infections worldwide, with 10-30% of patients suffering from post-acute sequelae of SARS-CoV-2 infections (PASC). Initially thought to primarily affect the respiratory system, it is now known that SARS-CoV-2 infection and PASC can cause dysfunction in multiple organs, both during the acute and chronic stages of infection. There are also multiple risk factors that may predispose patients to worse outcomes from acute SARS-CoV-2 infection and contribute to PASC, including genetics, sex differences, age, reactivation of chronic viruses such as Epstein Barr Virus (EBV), gut microbiome dysbiosis, and behavioral and lifestyle factors, including patients' diet, alcohol use, smoking, exercise, and sleep patterns. In addition, there are important social determinants of health, such as race and ethnicity, barriers to health equity, differential cultural perspectives and biases that influence patients' access to health services and disease outcomes from acute COVID-19 and PASC. Here, we review risk factors in acute SARS-CoV-2 infection and PASC and highlight social determinants of health and their impact on patients affected with acute and chronic sequelae of COVID-19.
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Affiliation(s)
- Chumeng Wang
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Akshara Ramasamy
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Monica Verduzco-Gutierrez
- Department of Physical Medicine and Rehabilitation, University of Texas at San Antonio, San Antonio, TX, USA
| | - W Michael Brode
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Esther Melamed
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
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50
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Kirchberger I, Meisinger C, Warm TD, Hyhlik-Dürr A, Linseisen J, Goßlau Y. Post-COVID-19 Syndrome in Non-Hospitalized Individuals: Healthcare Situation 2 Years after SARS-CoV-2 Infection. Viruses 2023; 15:1326. [PMID: 37376625 DOI: 10.3390/v15061326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Although "post-COVID-19 syndrome" (PCS) is reported to be common even in non-hospitalized individuals, long-term information on symptom burden, healthcare needs, utilization, and satisfaction with healthcare is scarce. The objectives of this study were to describe symptom burden, healthcare utilization and experiences with the healthcare offered for PCS in a German sample of non-hospitalized persons 2 years after SARS-CoV-2 infection. Individuals with past COVID-19 confirmed by positive polymerase chain reaction testing were examined at the University Hospital of Augsburg from 4 November 2020 to 26 May 2021 and completed a postal questionnaire between 14 June 2022 and 1 November 2022. Participants who self-reported the presence of fatigue, dyspnea on exertion, memory problems or concentration problems were classified as having PCS. Of the 304 non-hospitalized participants (58.2% female, median age 53.5), 210 (69.1%) had a PCS. Among these, 18.8% had slight to moderate functional limitations. Participants with PCS showed a significantly higher utilization of healthcare and a large proportion complained about lacking information on persistent COVID-19 symptoms and problems finding competent healthcare providers. The results indicate the need to optimize patient information on PCS, facilitate access to specialized healthcare providers, provide treatment options in the primary care setting and improve the education of healthcare providers.
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Affiliation(s)
- Inge Kirchberger
- Epidemiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Christine Meisinger
- Epidemiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Tobias D Warm
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Alexander Hyhlik-Dürr
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
| | - Jakob Linseisen
- Epidemiology, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology-IBE, LMU Munich, 81377 Munich, Germany
| | - Yvonne Goßlau
- Vascular Surgery, Faculty of Medicine, University of Augsburg, 86156 Augsburg, Germany
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