A mixed-methods analysis of the implementation of a new community long-COVID service during the 2020 pandemic: Learning from practice

Abstract

Introduction The rapidly increasing prevalence of long-COVID (LC), a condition characterised by multisystem complexity and high patient symptom burden, posed an immediate need to develop new clinics for assessment and management. This article reports on the rapid implementation of a reactive and responsive LC care pathway. We mapped patients’ journeys through this pathway, identifying the services that were activated according to prevalent symptoms, and used the Theoretical Domains Framework (TDF) to assess the barriers and facilitators to its implementation and delivery, from the perspective of health care professionals (HCPs) and LC patients. Methods Mixed methods study, including retrospective quantitative cross-sectional analysis of patient data and semi-structured qualitative interviews. One hundred and sixteen patients who attended the long-COVID clinic in Hertfordshire, UK, in the first 5 months of its existence and consented for their data to be analysed. Six HCPs and five patients participated in semi-structured interviews. Results Patients were referred into the service an average of 5.75 months post initial COVID-19 infection. 82% of patients required onward referral to other HCPs, most commonly pulmonary rehabilitation, chronic fatigue specialists, and a specialist COVID-19 rehab general practitioner embedded within the service. Patients reported having rehabilitation needs, moderate depression and anxiety, and difficulties performing usual activities for daily living. The TDF domains most relevant to the implementation of the LC pathway were beliefs about capabilities, environmental context and resources, knowledge, and reinforcement. Discussion Our study provides novel insight into the development of a reactive multidisciplinary care pathway. Key drivers for successful implementation of LC services were identified, such as leadership, multidisciplinary teamwork, transferable skills, and knowledge exchange. Barriers to rapid set up of the service included funding constraints and the rapid evolution of an emergency context.