Pub 5 2021 Issue1

telehealth visits in the outpatient setting. Through the summer, more and more patients became ill and like all physicians working in outpatient care, Harris and her colleagues were developing protocols on how to provide care to those patients. In June, Harris starting seeing patients in the clinic who had been sick with COVID early on but were still struggling with symptoms. Initially, she and other physicians hearing similar stories from patients did not know it was chronic COVID until she started reading articles from New York where they were seeing patients who were still experiencing symptoms months later. One of Harris’ patients in particular was sick with COVID in March, but still had chronic symptoms until late September. That patient never had to be hospitalized for his COVID, only given supplemental oxygen. In those early months, there was little information available to provide guidance for physicians to help these patients. Over the summer, Dr. Harris started researching and found landmark articles that had been published; one out of Italy and one from the British Medical Journal (BMJ). The articles described a high percentage of patients hospitalized with COVID who continued to have symptoms months later. Harris and her colleagues at Intermountain Healthcare began seeing more and more patients with symptoms lasting much longer than you would expect with a typical influenza. Intermountain Healthcare was part of a report on these lingering symptoms in Morbidity and Mortality Weekly Report (MMWR). With more data and information to work with, Harris, along with her colleague, Dr. Eliotte L. Hirshberg, worked with internal and family medicine physicians to develop protocols and care guidelines for Intermountain providers. Developing Dedicated Care for Post-COVID Patients When the University of Utah started discussing the development of a clinic devoted to providing post-COVID care, Dr. Jeanette Brown was a natural fit for designing such a clinic. Most of Dr. Brown’s work is multi-disciplinary in nature as she treats with patients with conditions such as amyotrophic lateral sclerosis (ALS) and muscular dystrophy who require care from multiple specialists to manage their symptoms and improve quality of life. Initially the University of Utah had hoped to develop the post-COVID clinic to be similar to their ALS clinic where patients would come to the clinic and spend around two and half hours there, seeing all of their providers and specialists, who were also able to interface with each other in that space. However, when Dr. Brown and her colleagues started looking at the volume of patients they would be treating, they knew that model would not be possible. The clinic will treat two types of patients: the patients admitted to the hospital who need post-ICU care and those who were not very sick to begin with, but are still struggling with symptoms months later. The first population will be seen primarily by physical medicine and rehabilitation (PM&R) physicians and pulmonary clinicians due to the prevalence of respiratory issues in this group. For these patients, the clinic will interface with primary care providers as well, providing notes and updates. Physicians in the clinic can also start making referrals for other specialized care such as neuropsych testing and neurology for those who have had a stroke. There are care pathways in place through e-consults or true consults for all those who need to be referred to for subspecialties. For those patients in the second population, they can be referred to a primary care physician if they do not already have one. “This can be a great opportunity to get patients connected into primary care; whether they need geriatrics, internal medicine, or family medicine,” Brown states. For patients who have already established care with a provider, those providers will have access to care coordinators and e-consult referrals to get their patients set up with testing if needed. The Post-COVID Clinic has three primary goals: 1. Provide state of the art care for patients and continue to monitor and adapt to the latest best practices. 2. Support the providers by helping clinicians through the ambiguity of treating these patients through a learning collaborative. It will involve specialists including Dr. Barbara Jones from the Veterans Administration Hospital in Salt Lake City, Dr. Lucinda Batemen from the Bateman Horne Center, and Dr. Harris from Intermountain Healthcare. The collaborative will take place during lunch hour over Zoom. The format will The key thing that PCPs can do is doing a really good job of looking at the medications that they were on before and then after the hospitalization. I have seen some really scary mistakes happen in terms of medication management after several care team transitions. Post-COVID Care | Continued from page 27 UtahAFP.org | 28