Post-COVID-19 Syndrome Clinical Pathway for the US Veterans Health Administration.

Claudia L Campos, Cristina Nguyen, Kristina Crothers, Omar Awan, Francis J Miller, Courtney Sedillo, Johnson Vachachira, Carrie B May, Allison M Gustavson, Jacob B Lindheimer
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Abstract

The Department of Veterans Health Affairs (VHA) has launched 22 multispecialty post-COVID-19 clinics across the US for the growing number of veterans experiencing long-term sequelae after acute COVID-19 infection. While evidence-based treatments for this syndrome are under investigation, there is a critical need to establish and disseminate clinical pathways (CPWs) based on knowledge and experience gained in those clinics. This VHA CPW is intended to guide primary care clinicians who care for patients experiencing dyspnea and/or cough during post-COVID-19 syndrome (PCS), which includes symptoms and abnormalities persisting or present beyond 12 weeks of the onset of acute COVID-19. This effort will help guide and standardize the care of veterans across the VHA, improve health outcomes, and effectively utilize health care resources. This article summarizes our stepwise diagnostic approach for patients presenting with PCS dyspnea and/or cough in primary care; it also highlights teleconsultation and telerehabilitation as opportunities to reach those in rural areas or with transportation barriers and improve reach for specialized services.

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美国退伍军人健康管理局的后 COVID-19 综合征临床路径。
退伍军人健康事务部(VHA)已在全美开设了 22 家多专科 COVID-19 后门诊,为越来越多的退伍军人治疗急性 COVID-19 感染后的长期后遗症。虽然针对该综合征的循证治疗方法正在研究中,但亟需根据这些诊所获得的知识和经验建立和推广临床路径 (CPW)。该 VHA CPW 旨在指导初级保健临床医生护理 COVID-19 后综合征 (PCS) 期间出现呼吸困难和/或咳嗽的患者,该综合征包括急性 COVID-19 发病 12 周后仍持续存在或出现的症状和异常。这项工作将有助于指导和规范整个退伍军人事务部对退伍军人的护理,改善健康状况,并有效利用医疗资源。本文总结了我们针对初级医疗中出现 PCS 呼吸困难和/或咳嗽的患者所采取的逐步诊断方法;文章还强调了远程会诊和远程康复服务,这些服务可帮助农村地区或交通不便的患者,并提高专业服务的覆盖率。
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