Long COVID Examining Long-Term Health Effects of COVID-19 and Implications for the Social Security Administration: Proceedings of a Workshop (2022) / Chapter Skim
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6 Clinical Practices and System Approaches for Improving Health and Recovery from Long COVID
6 Clinical Practices and System Approaches for Improving Health and Recovery from Long COVID
Pages 73-86
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From page 73... ...
CLINICAL GUIDANCE STATEMENTS Steven Flanagan, professor and chair of rehabilitation medicine and medical director of Rusk Rehabilitation at NYU Langone Health, shared the experiences of the American Academy of Physical Medicine and Rehabilitation (AAPM&R) in developing and disseminating guidance on Long COVID for its members.
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The collaborative uses a systematic process for the development of guidance statements and involves an equity subcommittee to ensure that the statements address equal access and care for subpopulations. Thus far, the PASC Collaborative has published guidance statements on cognitive symptoms, breathing discomfort and respiratory sequelae, and fatigue.1 The statements, said Flanagan, are based on the experience and expertise of people working and living in the world of Long COVID.
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(CDC, 2021a) Abramoff and his colleagues conducted a survey of post-COVID clinics to see how integrated care models have been implemented at different locations (Dundumalla et al., 2022)
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SOURCE: Benjamin Abramoff presentation, March 22, 2022, based on data from Dundumalla et al., 2022, p. 352, © 2022 American Academy of Physical Medicine and Rehabilitation.
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• No research yet suggests if one model is more effective than others. INTEGRATED CARE MODEL: PEDIATRIC POPULATION As of March 10, 2022, said Amanda Morrow, assistant professor of physical medicine and rehabilitation at the Johns Hopkins School of Medicine and codirector of the Pediatric Post-COVID-19 Rehabilitation Clinic at Kennedy Krieger Institute, there have been almost 13 million pediatric cases of COVID-19 in the United States, accounting for almost 20 percent of the total cases (American Academy of Pediatrics, 2022)
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SOURCE: Benjamin Abramoff presentation, March 22, 2022.
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The benefits of multidisciplinary specialty clinics include a holistic approach to care, increased communication and coordination, and decreased appointment burden, which can be helpful for disorders with multiple organ system involvement. This approach also has challenges, she said, such as having the institutional infrastructure to support a clinic with adequate space, and managing insurance coverage issues, including limits placed on the number of providers a patient can see in one day.
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The goals of this collaboration, said Morrow, are to develop guidelines, and to create standardized definitions and data harmonization tools to better understand pathophysiology and treatment. In closing, Morrow highlighted key messages: • Similar to integrated care models in other complex pediatric illnesses, children with Long COVID may also benefit from multidisciplinary, team-based approaches to care.
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From page 81... ...
Clinicians should not limit themselves to the individual or biomedical domain, said Berger, but should work to reduce inequities by, for example, advocating for eviction moratoriums, providing economic support for workers, providing language concordant care, and decarcerating. In short, said Berger, "We need to empower and emphasize structural equity and epistemic humility." We need solidarity between health care workers and patients, we need to empower patients to take control, and we need to listen to those with Long COVID about their experiences, he concluded.
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523, in Zackary Berger presentation, March 22, 2022.
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• Potential policy measures include strengthening primary care, optimizing data quality, and addressing the multiple nested domains of inequity. DISCUSSION Following the presentations, Verduzco-Gutierrez moderated a questionand-answer session, posing questions from planning committee members, representatives from SSA, and other workshop participants.
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Morrow added that the pediatric guidance that will be coming out soon is designed to be helpful for primary care pediatricians; it is symptom based but includes guidance on initial workup and treatment recommendations. How are integrated specialty clinics measuring the effectiveness of their work?
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Verduzco-Gutierrez agreed that the process is overwhelming, and she added that some disability insurance companies deny patients because the companies do not take into account symptoms like postexertional malaise or the unseen fatigue that follows cognitive work.
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