Long Covid Rehabilitation Assessment Clinic Overview
This content provides insights into the operations, initiation, prevalence data, patient flow modeling, assessment criteria, and services offered by the BSW Long Covid Rehabilitation Assessment Clinic in Wiltshire. The clinic focuses on supporting individuals with persistent Covid-19 symptoms, offering tailored assessments, treatment plans, referrals, and follow-up care to aid in recovery and improve quality of life.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.
E N D
Presentation Transcript
BSW Long Covid Rehab Assessment Clinic Carol Langley-Johnson Head of Operations long term conditions and MSK, Wiltshire Health and Care Jane Clarke Clinical Lead, Clinical Specialist MSK Physio, Wiltshire Health and Care Lucy Baker Director of Planning and Transformational Programmes BSW CCG Bswccg.postcovidpathway@nhs.net
How did it all start ? BSW steering Group 13/11/20 to co-create model following national ask clinical representatives from acute, mental health and community providers along with GP, commissioners and people with lived experience ( including doctor with long covid) Service commissioned from Wiltshire Health & Care. Focus on community based provision and support to de-medicalise and reduce preventable secondary care referrals Pre-existing core components within AHP rehab services & MSK pathway Community focused pathways with good links to PCNs and local authorities with prescription programs Initial model went live 2/12/2020 in line with national deadline NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Population prevalence data Dec 2020 -22% Of pts in England who have had Covid-19 have persisting symptoms 5-12 weeks . It is estimated that between 10% and 35% of patients who have Covid will have ongoing effects after 21 days or more. Recovery seen in hospitalised patients by 5 months at 40% Tier 1 self management & YCR platform predict 50 % Tier 2- primary care / community support 35% Tier 3 specialist / secondary care 15% Unlike in acute Covid where ethnicity is adversely affected by covid, long covid does not have the same bias NHS Bath and North East Somerset, Swindon and Wiltshire CCG
UCL modelling Long Covid Patient Flow NHS Bath and North East Somerset, Swindon and Wiltshire CCG
BSW Long Covid Assessment Clinic Screened within 72hours Accepted for Tel/video/home visit Ax 12 weeks or over since Covid symptoms Symptoms consistent with Covid GP electronic referral Full blood count within 8 weeks of ref Chest XR (within 12 weeks) if persistent breathlessness Screened within 72hours rejected with reason. If under 12 weeks signposted resources Aged 14 or older Appropriate referrals made eg cardiology, respiratory, psychology. NHS Bath and North East Somerset, Swindon and Wiltshire CCG
BSW Long Covid Assessment Clinic What is it? 60 min Telephone or Video Assessment Exercise Test Personalised Treatment Plan Resources Referrals MDT PMH Meds Resting BP, Sats, HR & BORG 1 min Sit to Stand Repeat obs 6 min timed walk Repeat obs Finalise Action Plan EQ5D, 6CIT, Chalders WHODAS 2.0 The Covid experience Investigations Impact of CV What have they tried? Main problems Main goals Action goals PHQ9 and GAD NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Key Features of the emerging long term condition Variable presentation Psychological Impact Fatigue Brain Fog Deconditioning & Sarcopenia 51 % pts have mod-severe anxiety Dysfunctional breathing 39% Have mod severe depression Post Exertional malaise 30 % report PTSD Heart rate variability BSW data shows Av Moderate Anxiety & depression POTs, Arrthymias Poor sleep NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Results to date 111 BaNES 99 Swindon 179 Wiltshire 10 Others 399 TOTAL Days between referral and assessment Under 7 days 7-13 14-20 21-27 28-34 35-41 42+ Average 19 working days Range 3 to 48 working days 16 17 22 24 36 41 2 Referrals on Jan-21 Feb-21 Mar-21 TOTAL Referred to long covid rehabilitation service 11 18 36 65 Referred to RUH Chronic Fatigue Service 1 3 12 16 1 1 7 9 Referred to dietitian NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Data Ethnicity Baltic Estonian/Latvian/Lithuanian Black Caribbean Chinese Indian or British Indian Other White European Pakistani or British Pakistani Mixed ethnicity White British Deprivation decile Most deprived 1 2 3 4 5 6 7 8 9 Least deprived 10 1 1 1 5 2 1 1 76 Age Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ 1 6 20 24 60 35 8 4 0 3 7 6 6 Median age 50 Range 15 - 83 13 15 12 26 30 30 NHS Bath and North East Somerset, Swindon and Wiltshire CCG
GAD7 Anxiety scores = median 6 NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Depression PHQ9 = median 10 NHS Bath and North East Somerset, Swindon and Wiltshire CCG
BSW Virtual MDT Occupational Therapist Cardiologist Commissioner Respiratory Physiotherapist Occupational Health Physician GP Respiratory Consultant MSK Psychologist Physiotherapist Respiratory Nurse Clinical lead Bath Fatigue Service Dietician NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Important components SBAR template for patient presentation Spreadsheet tracking decisions & outcomes to aid learning Terms of reference Reliable committed clinicians, at least 1 medic at each session Established trusted relationships, supported by AHP BSW council Learning from each other NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Discharge options Wiltshire Health and Care Rehab pathway BaNES Rehab pathway Swindon Rehab pathway Yourcovidrecovery interactive platform Bath Centre for Fatigue Services Self management NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Healthy Futures a virtual programme; Led by Specialist OT Managing Activity part 2 Thoughts and Feelings Intro Managing Activity part 1 CV Physiology Covid journey Goal intro Cognitive fatigue & Communication Reconditioning & Pacing exercise Managing Breathlessness Managing Anxiety and setback planning Optional add on Return to work planning NHS Bath and North East Somerset, Swindon and Wiltshire CCG
RISKS GPs referring inappropriate pts with lack of investigations or review Diagnostic delays where patients incorrectly labelled with long Covid Ability of Psychology to respond in timely way Sustainability of staffing capacity once normal services return Developing staff competencies - meet the needs of pts with an emerging long term condition The ability to discharge and move on pts to self directed recovery Management of Paeds by adult respiratory services. NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Future Plans Sensitively address Health Inequality Building the BSW Post covid clinical network Develop a consistent tier 2 offer across BSW We need to keep Learning; link with other sites, collecting & presenting data BSW Clinician educational Webinar Long covid on 25th May at 12.30 Extend links to post ICU pathway & Oximetry @Home team Evaluate MDT NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Honour the story of the patient whose protracted recovery was unexpected, alarming and does not make sense NHS Bath and North East Somerset, Swindon and Wiltshire CCG
Further reading Updated estimates of the prevalence of long COVID symptoms - Office for National Statistics (ons.gov.uk) SARC-F SARCOPENIA QUESTIONNAIRE Post-covid syndrome in individuals admitted to hospital with covid-19: retrospective cohort study | The BMJ NHS Bath and North East Somerset, Swindon and Wiltshire CCG
