RESUMEN
IntroductionAs mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs. Methods and analysisThis study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID. Ethics and disseminationEthical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID. RegistrationResearchregistry: https://www.researchregistry.com/browse-the-registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/.
RESUMEN
ObjectivesHealthcare workers have a greater exposure to individuals with confirmed SARS-novel coronavirus 2, and an estimated 5-fold higher probability of contracting coronavirus disease (COVID)-19, than the general population. Many organisations have called for risk assessments to be put in place to minimise this risk. We wished to explore the predictive role of basic demographics in order to establish a simple tool that could help risk stratify healthcare workers. SettingWe undertook a review of the published literature (including multiple search strategies in MEDLINE with PubMed interface) and critically assessed early reports on medRxiv, a pre-print server (https://www.medrxiv.org: date of last search: December 21, 2020). We explored the relative risk of mortality from readily available demographics in order to identify the population at highest risk. ResultsThe only published studies specifically assessing the risk of healthcare workers had limited demographics available, therefore we explored the general population in the literature. Clinician DemographicsMortality increased with increasing age from 50 years onwards. Male sex at birth, people of black and minority ethnicity groups had higher susceptibility to both hospitalisation and mortality. Co-morbid Disease. Vascular disease, renal disease, diabetes and chronic pulmonary disease further increased risk. Risk stratification toolA risk stratification tool was compiled using a Caucasian female <50years with no comorbidities as a reference. A point allocated to risk factors associated with an approximate doubling in risk. This tool provides numerical support for healthcare workers when determining which team members should be allocated to patient facing clinical duties compared to remote supportive roles. ConclusionsWe have generated a tool which can provide a framework for objective risk stratification of doctors and health care professionals during the COVID-19 pandemic, without requiring disclosure of information that an individual may not wish to share with their direct line manager during the risk assessment process. Strengths and limitations of this studyO_LIThere is an increased risk of mortality in the clinical workforce due to the effects of COVID-19. C_LIO_LIThis manuscript outlines a simple risk stratification tool that helps to quantify an individuals biological risk C_LIO_LIThis will assist team leaders when allocating roles within clinical departments. C_LIO_LIThis tool does not incorporate other external factors, such as high-risk household members or those at higher risk of mental health issues, that may require additional consideration when allocating clinical duties in an appropriate clinical domain. C_LIO_LIThis population-based analysis did not explain for the very high risk observed in BAME healthcare workers suggesting there are other issues at play that require addressing. C_LI
