A technology-enabled multi-disciplinary team-based care model for the management of Long COVID and other fatiguing illnesses within a federally qualified health center: protocol for a two-arm, single-blind, pragmatic, quality improvement professional cluster randomized controlled trial

Health Insurance and Access to Care in U.S. Working-Age Adults Experiencing Long COVID

INTRODUCTION

Long COVID encompasses a wide range of health problems that emerge, persist, or recur following acute coronavirus disease 2019 (COVID-19) illness. Given that the prevalence of self-reported Long COVID is highest among U.S. adults in their prime working years, it is important to identify unmet needs and gaps in healthcare access and coverage among working-age adults.

METHODS

Prevalences (95% confidence intervals [CI]) of health insurance coverage and access to care by Long COVID status were estimated among adults 18-64 years (n=18,117), accounting for survey design and weighted to the U.S. non-institutionalized population in the 2022 National Health Interview Survey. Analyses were conducted in 2023.

RESULTS

Overall, 3.7% (95% CI 3.4, 4.0) of respondents were experiencing Long COVID. Adults experiencing Long COVID were less likely to report being uninsured relative to adults not experiencing Long COVID (p=0.004); however, 49.0% (95% CI 43.2, 54.7) had high deductible health plans. Adjusting for sociodemographic characteristics, adults experiencing Long COVID were more likely to access healthcare compared to adults not experiencing Long COVID (p<0.01 for seeing a doctor, telemedicine appointments, ≥2 urgent care visits, ≥2 emergency department visits, and hospitalized overnight). Despite more frequent healthcare use, adults experiencing Long COVID were also more likely to abstain from and delay medical care, therapy, and prescriptions due to cost compared to adults not experiencing Long COVID (p<0.0001 for all comparisons).

CONCLUSIONS

These findings may be used to inform healthcare planning for adults experiencing Long COVID and highlight the ongoing need to improve access and affordability of quality and comprehensive care.

Six years of Project ECHO: Implementation and evaluation of a hospice-led multiprofessional education programme

Objectives: This article reports on the implementation and evaluation of an established technology-enabled collaborative learning programme (Project ECHO) at an independent UK hospice in the North of England over a 6-year period. Methods: An independent audit of collated, anonymised data from the programme is used to report attendance patterns and session evaluations. Results: The results show a gradual increase in attendances, programmes, sessions and hours of education, coupled with consistently positive evaluation reports. Conclusion: This supports existing evidence that Project ECHO is an effective method of delivering remote healthcare education, demonstrating impact on the first three levels of Moore's education framework; participation, satisfaction and learning. Future expansion in terms of geography and topics covered is proposed, alongside enhanced evaluation methods to demonstrate impact at the higher levels of Moore's framework.

Burnout, Compassion Fatigue, and the Long Haul of Caring for Long COVID

The current landscape of clinician burnout is prompting the need for our health care system to revise its approach toward complex conditions such as long coronavirus disease (COVID), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and other postinfectious fatiguing illnesses (PIFIs). We discuss our efforts here at Family Health Center of San Diego (FHCSD) to help share insight and glean perspective from clinicians who have participated in our Centers for Disease Control and Prevention (CDC)-funded 3-year continuing professional development initiative. The Long COVID and Fatiguing Illness Recovery Program uses multidisciplinary team-based case consultation and peer-to-peer sharing of emerging best and promising practices (ie, teleECHO [Extension for Community Healthcare Outcomes]) to support the management of complex cases associated with long COVID, ME/CFS, and other PIFIs. We believe that this perspective captures a key moment in the trajectory of postpandemic clinician burnout and prompts further reflection and action from the health care system to improve clinician- and patient-level outcomes related to the care of patients with postinfectious fatiguing illnesses.