Pub 5 2021 Issue1

include presentations on the latest research and then will allow providers time to present cases they are struggling with. Set up much like a tumor board for cancer patients, providers can both ask for and give advice on how to provide treatment in each case. 3. Research will also be a large component of the clinic. They are discovering that many patients are altruistic and interested in helping doctors and researchers determine causes and treatment. The clinic will provide multiple opportunities for patients and others from the community to be a part of this ongoing research. The University of Utah serves an impressive geographical catchment area: Wyoming, Idaho, Montana, Nevada, Arizona, and parts of Colorado. The other closest full post- COVID clinics will be in Colorado, New Mexico, and San Diego, so the University of Utah has the potential to see a large number of patients from hundreds of miles away. To provide care for patients far afield of Salt Lake City, the clinic will be working with primary care doctors throughout the region through telemedicine to determine if patients need further care with specialists. One of Dr. Brown’s greatest concerns is to not squeeze out patients already being seen by the specialists who will now also be caring for those in the post-COVID clinic. Colorado’s clinic, for example, has 400 active patients and their waitlist is 1400. To ensure that does not happen, they have to recruit all the primary care assistance they can as it is going to take time for patients to be seen. And while the clinic is located at the University of Utah’s main hospital complex, most initial visits will be with advanced practice clinicians over telehealth. Resource and time constraints will be aided by the implementation of the learning collaborative so that doctors can learn how to provide care for patients before they are able to be seen by the Post-COVID clinic or other specialists, as getting appointments can take several months. The Critical Role of Family Physicians in treating Long COVID Navigating the Medical System Many people with lingering symptoms may not be used to navigating a complex medical system. Primary care can serve as the “ringleader” of the specialties by providing continuity of care, because many of these patients may need to see several specialists. They are the center piece of these long haulers, helping them migrate through the systems. Teaching Patience and Providing Validation It is important to teach patients that sometimes the symptoms from the virus do not go away in two weeks while also screening for more serious side-effects such as a pulmonary embolism. Most of the models where guidelines are being developed are coming through primary care and are holistic in their approach. Dr. Harris says, “I’m just an adjunct to our primary care colleagues. I am lucky that I am on the same floor with family medicine and internal medicine docs. We do a lot of talking back and forth between primary care and specialists about managing patients and what to expect. Primary care is really the driver in most of these patients. We are learning from our patients and sharing information with each other. New guidelines and approaches are being developed all the time.” Help Patients Pace Themselves and Recognize Their Own Improvement When Dr. Harris sees patients with long COVID she utilizes patient scales similar to those used when treating anxiety and depression, where patients can rate their symptoms and functionality at each visit. Harris says it can be very therapeutic for patients to be able to see their improvement over time through the use of those scales. She also often performs walking oxygen testing, complete blood count (CBC), checks inflammatory markers, and electrocardiograms (EKG) for patients with any kind of tachyarrhythmia. Dr. Harris also cautions over-exertion for patients, both physical and mental, for long COVID patients as exercise can backfire. Increase in activities should be very gradual and monitored for relapse of symptoms. Dr. Brown recognizes that one of the most challenging components of caring for patients struggling with debilitating long COVID symptoms is trying to help them navigate qualifying for FMLA or disability coverage as it is resource intensive process and there is no way to bill for that time. For that challenge, unfortunately, she does not have a great answer. She recommends trying to team up with other doctors who are struggling with the increased demand or looking at working with nurses and medical assistants who can potentially devote more time helping patients with the paperwork. What is the most important advice you can pass on to family physicians? Dr. Brown emphasizes three key actions for primary care providers to take when their patients have been hospitalized or seen by other specialists: “When you get a discharge summary or notes look at a) what happened, b) what needs to be followed up on and c) does their medication list make sense any longer? 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.” Dr. Harris states that listening to patients and providing validation is key for patients with long COVID. “Patients are very grateful to their physicians when we sit and listen to them and validate - just to listen and give patients different coaching. One of the biggest things is pacing. In the first few months of treating long COVID patients, I heard about a new, weird symptom almost every day and it was very humbling. [Listening and validating] this is what family docs do best. This skill set is critical, and the value of family docs has never been higher than now.” Find more resources about caring for long COVID-19 patients at utahafp.org/longcovid. 29 |