Juana Ramírez
CEO and Founder
Grupo Sohin
Expert Contributor

Post-COVID Care, Follow-Up Key for Long-Term Health

By Juana Ramírez | Tue, 03/16/2021 - 09:11

The COVID-19 pandemic is posing considerable challenges to healthcare systems and societies. From its first mention in December 2019, COVID-19 quickly progressed into a major public health concern for Mexico’s private and public healthcare system.

Complications beyond the initial period of acute infection and illness became a target for multidisciplinary clinics worldwide. The list of persistent and new symptoms reported by patients is extensive. Within the past year, a large population of survivors with prolonged post-infection symptoms have been reported. However, pandemic-related inpatient service demands, disrupted ambulatory practices, social distancing and physical space limitations require creative adaptation. Our model combines telehealth visits, followed shortly thereafter by an in-home, comprehensive medical evaluation. Our core belief is that rehabilitation programs should be individualized and adapted to accommodate the needs of the patient.

The post-COVID clinic at SOHIN was created to provide ongoing care and assessment of adult patients who are recovering from COVID-19. The clinic is designed to treat patients who are still experiencing symptoms as well as to monitor for any late effects of COVID-19 infection.  Several reports identify and address non-pulmonary sequelae, including extrapulmonary organ dysfunction, physical rehabilitation needs, cognitive impairments and psychosocial vulnerabilities. Acute cardiac, neurological, neuromuscular and hematological complications had significant implications for our post-COVID-19 clinical program design. Patients will have access to specialists in primary care, cardiology, pulmonary medicine, hematology, nutritional specialists and neurology as well as to mental health providers.

Each patient will receive a care plan customized to their specific needs and our outpatient care managers will facilitate all assessments and visits that may be needed. Because the long-term effects of COVID-19 infections are not yet known, comprehensive follow-up and evaluation of patients who are recovering is important for optimizing long-term health. At discharge, patients with COVID-19 are given pulse oximeters and enrolled in a four- to 12-week monitoring program supervised by an internal medicine specialist care coordinator. Finally, we have optimized patient and provider use of the electronic health record with Salesforce Health Cloud.  This facilitates pre-visit completion of patient-reported symptom measures across multiple domains, improving the clinic’s efficiency and increasing patient engagement.

The follow-up program at the post-COVID clinic at SOHIN is an outpatient benefit offered to individuals previously hospitalized with COVID-19, including those who required critical care support, and non-hospitalised individuals with persistent respiratory symptoms following COVID-19. We consider our impact crucial to minimize long-term morbidity and mortality associated with COVID-19.

Photo by:   Juana Ramírez