A: Access |
Services should be accessible to everyone with long COVID regardless of COVID positive PCR, antibody test or hospitalisation status. However, as the evidence base and diagnostic criteria develop, referral criteria to specialist services may need refinement to ensure optimal resource utilisation. A range of contact and consultation approaches including telephone, video and face-to-face should be considered as appropriate and adjustments make to ensure those with new or chronic disabilities are not disadvantaged. |
B: Burden of illness |
The burden of treatment needs to be minimised. A ‘one-stop shop’ model could facilitate this, such as those developed for other complex conditions (eg memory impairment). Alternatively, a shared care model, with clearly defined care pathways disseminated between the community and secondary care is likely to be more achievable for many localities and accords with the Department of Health's long-term conditions model. Such approaches have been applied for over 10 years to multisystem conditions including inflammatory arthritides and diabetes or mental health problems. Outcomes are non-inferior to those achieved through secondary care management and may benefit from enhancing patients’ self-efficacy, confidence and satisfaction, and cost-efficacy.22,23 Successful integration relies on coordination between commissioners and providers, adequate financial resources and appropriate governance structures. |
C: Clinical responsibility and continuity of care |
A named clinician must be responsible for the patient at every stage. Management and relationship continuity combined with clinical responsibility are essential in any multisystem or chronic condition. They are associated with patient and physician satisfaction; reduced clinician collusion of anonymity; physician trust; and, therefore, treatment adherence, problem recognition and quality of management, and reduced healthcare utilisation and associated costs.22 Such continuity has also been shown to improve outcomes in rehabilitation care settings; of particular relevance for long COVID.23 |
D: MultiDisciplinary rehabilitation services |
Services must be multidisciplinary. Integrated care requires professionals and practitioners from different backgrounds to work together to improve patient outcomes. Multidisciplinary team structures provide a shared identity and purpose encouraging trust; a more holistic and person-centred practice; minimising errors and associated harms; improving efficiency of resource utilisation; and reducing professional isolation and stress.24 From cancer care to rehabilitation, such approaches have been widely implemented within the NHS to improve clinical outcomes, patient and family experience, and professional satisfaction.25 |
E: Evidence-based standards |
Evidence-based standards must be developed to guide consistent symptom management. These should guide the exclusion of potentially serious complications, management of new or existing comorbidities, and holistically address symptoms and should acknowledge the best available evidence or consensus of best practice in the context of a rapid, dynamic context, rather than holding out for randomised controlled trials. Importantly, while consideration of psychosocial factors is crucial, symptoms (such as fatigue or ‘brain fog’) should not be ascribed to these issues without consideration of, and research into, other causes. |
F: Further development of the knowledge base and clinical services |
Patients must be offered the opportunity for involvement in further research and service development, which should be enabled by the development of registries of patient data and facilitated through long COVID services. This reflects the key principles of patient-centred medicine and such experience-based co-design also improves alignment of research and service aims with patient priorities; development of meaningful and useful studies and services, in which patients are keen to participate; identification and minimisation of barriers to access or utilisation; enhanced patient education, information dissemination, and application of research findings; and improved patient experience and cost efficiency. |