Long-term Covid clinic expands to vulnerable metro, rural communities | Washington University School of Medicine in St. Louis

In 2020, overburdened hospitals and excess mortality defined a world struggling with the COVID-19 pandemic. At the same time, a new challenge emerged. growing population struggled to fully recover from COVID-19.

Patients have coined the term “long COVID” to describe their long-term health challenges, which can last months after the initial coronavirus infection. Eventually, long-term COVID clinics, programs aimed at treating patients with long-term COVID, opened across the country, including at the Washington University School of Medicine in St. Louis.

Now, School of Medicine physicians and researchers are working with community partners to identify needs and provide better services to medically vulnerable and underserved communities in metro St. Louis and rural Missouri. The University of Washington Health Team has been awarded a five-year grant totaling $4.5 million from the US Department of Health and Human Services through the Agency for Healthcare Research and Quality. The grant was also awarded to eight other teams across the country.

“Rural communities in St. Louis and Missouri have been disproportionately affected by COVID-19 and have not always had access to the long-term COVID care they need and deserve,” said Washington University’s Dr. Abby L. Cheng. physical medicine and rehabilitation physician and principal investigator for the grant. “Community collaboration involving patients, trusted community organizations, primary care teams, medical subspecialists and experts in other health disciplines aims to increase available resources for this underserved population.

“This grant will allow us to create solutions together.”

Matt Miller

Abby Cheng, a physical medicine and rehabilitation physician at the University of Washington School of Medicine, addresses a group of community partners, patients, physicians and other care providers at a November meeting at the University of Medicine to advance long-term COVID-related care in the community. .

Community partners include the St. Louis Integrated Health Network, St. Louis Regional Health Commission and four St. Louis Qualified Health Centers (FQHCs). The latter are outpatient clinics eligible for Medicare and Medicaid reimbursement and offer comprehensive, high-quality primary care and preventive services regardless of patients’ ability to pay.

Washington University’s long-term COVID-19 clinic opened in October 2020. Given the overwhelming need and multifaceted nature of the disease, the School of Medicine’s multidisciplinary team of health care providers provides care for long-term COVID patients. The clinic, overseen by the school’s Division of Infectious Diseases, evaluates and refers patients to a variety of services, including the Living Well Center, a lifestyle-based medicine center within the Department of Orthopedic Surgery.

This initiative aims to increase and improve long-term COVID care in St. Louis and rural Missouri communities. It will support primary care physicians in the region as they diagnose and manage long-term COVID-related symptoms in their patients, in part by improving communication and the referral process between primary care teams and specialists at the University of Washington. Such partnerships are expected to reduce wait times and promote access to care.

“Our community partners have taught us that equipping primary care teams—the teams that already care for underserved patients every day—with practical clinical tools and updates on long-term COVID treatment options is a more effective, equitable strategy than simply increasing patient access. in our single clinic,” explained Cheng, assistant professor of orthopedic surgery. He added that many patients prefer to receive care at their trusted “medical home,” such as an FQHC, rather than navigate a university system if it’s unfamiliar to them.

Cheng recalled that the stories shared by longtime COVID-19 patients share a common thread: the persistent struggle to get care, like the north St. Louis resident who, unable to work remotely, contracted COVID-19 early in the pandemic. in the circle: The patient developed prolonged COVID that included breathing problems, brain fog, and fatigue. The illness resulted in a loss of work and therefore a loss of health insurance.

“We can’t help patients with their medical needs if we don’t address the social issue first,” said Cheng, who also has a master’s degree in population health sciences.

Matt Miller

Teresa S. Notestin, DPT, clinical practice manager and physical therapist at the University of Washington, listens as Tanya Dotson shares her struggles with prolonged COVID during a meeting at the University of Medicine in November. The goal of the gathering was to create a partnership to advance medical care for long-term COVID patients in underserved areas of metropolitan St. Louis and rural Missouri.

The funding will support two case managers to help patients access social resources and manage complex paperwork, including health insurance and financial assistance forms, which can be daunting even when debilitating symptoms are not present.

Long-standing COVID-related stigma and skepticism have also hindered patient care. The University of Washington team will partner with the Missouri Primary Care Association to spread knowledge, raise awareness, and improve communication and collaboration in areas that may be harder to reach, including rural Missouri communities with limited wireless and broadband access.

“Length of COVID-19 is real and ubiquitous,” Cheng said. “We’ve heard varying degrees of awareness about how long COVID can be, what causes it, and how to treat it. Because primary care physicians understand patients from their entire medical perspective, they are in a key position to recognize lingering COVID symptoms. They are also extremely busy. We want to support primary care teams with the tools they tell us they need to provide best practice long-term COVID care.”

The team collaborated with Myrna Becevic, MD, assistant professor of dermatology at the University of Missouri School of Medicine in Columbia, Mo. Results (ECHO). A multidisciplinary clinical team at the University of Washington will develop and deliver extended CoVID education sessions to this already established physician network. Such sessions aim to spread awareness of current best practices and encourage primary care physicians who care for rural and underserved patients in St. Louis and elsewhere in Missouri to discuss challenging patient cases.

Other University of Washington co-principal investigators on the grant include behavioral scientist Amy McQueen, Ph.D. and Dr. Jonas Marshall of Infectious Diseases, professors of medicine. The project is supported by a multidisciplinary team of long-term COVID-19 physicians, including key players Dr. Gayatri Krishnan, assistant professor of medicine and director of the Long-COVID Clinic, and Devyani Hunt, professor and medical director of orthopedic surgery. Living Well Center.

Matt Miller

Sarah Alleman, a nurse at the University of Washington, examines a patient for chronic COVID at the university’s chronic COVID-19 clinic.