Persistent symptoms after Covid-19: qualitative study of 114 "long Covid" patients and draft quality principles for services.
Persistent symptoms after Covid-19: qualitative study of 114 "long Covid" patients and draft quality principles for services.
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DOI：
10.1186/s12913-020-06001-y
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发表时间：
2020-12-20
影响因子：
2.8
通讯作者：
Greenhalgh T
中科院分区：
文献类型：
--
作者：
Ladds E;Rushforth A;Wieringa S;Taylor S;Rayner C;Husain L;Greenhalgh T
大约10%的Covid-19患者出现症状超过3-4周。患者称之为“长期新冠肺炎”。我们试图记录这些患者的生活经历，包括获得和接受医疗保健以及改善服务的想法。我们进行了55次个人访谈和8个焦点小组（n = 59），参与者来自英国长期的新冠肺炎患者支持团体、社交媒体和滚雪球。我们将一些焦点小组限制为卫生专业人员，因为他们已经自行组织成在线社区。与会者应邀讲述自己的故事，并对其他人的故事发表评论。使用NVIVO对数据进行录音、转录、匿名和编码。分析纳入了疾病，愈合，同伴支持，临床关系，访问和服务重新设计的社会学理论。在114名年龄在27-73岁的参与者中，80名是女性。84例为白色英国人、13例亚洲人、8例其他白色人、5例黑人和4例混合种族。其中32人是医生，19人是其他卫生专业人员。31人住院，其中8人已入院。分析显示，这是一种令人困惑的疾病，有许多不同的症状，往往是复发缓解症状，预后不确定;有严重的失落感和耻辱感;难以获得和导航服务;难以得到认真对待和诊断;脱节和孤立的护理（包括无法获得专家服务）;标准差异（例如，就诊、调查和转诊患者的标准不一致）;治疗关系的质量可变（一些参与者感到得到了很好的支持，而另一些参与者则感到“被忽悠”）;以及可能的关键事件（例如，无法获得服务后病情恶化）。参与者的经验中具有重要意义的方面为改进服务提供了信息。为长期的新冠肺炎服务建议的质量原则包括确保获得护理、减轻疾病负担、承担临床责任和提供连续性护理、多学科康复、循证调查和管理，以及进一步发展知识库和临床服务。NCT 04435041。
Approximately 10% of patients with Covid-19 experience symptoms beyond 3–4 weeks. Patients call this “long Covid”. We sought to document such patients’ lived experience, including accessing and receiving healthcare and ideas for improving services. We held 55 individual interviews and 8 focus groups (n = 59) with people recruited from UK-based long Covid patient support groups, social media and snowballing. We restricted some focus groups to health professionals since they had already self-organised into online communities. Participants were invited to tell their stories and comment on others’ stories. Data were audiotaped, transcribed, anonymised and coded using NVIVO. Analysis incorporated sociological theories of illness, healing, peer support, clinical relationships, access, and service redesign. Of 114 participants aged 27–73 years, 80 were female. Eighty-four were White British, 13 Asian, 8 White Other, 5 Black, and 4 mixed ethnicity. Thirty-two were doctors and 19 other health professionals. Thirty-one had attended hospital, of whom 8 had been admitted. Analysis revealed a confusing illness with many, varied and often relapsing-remitting symptoms and uncertain prognosis; a heavy sense of loss and stigma; difficulty accessing and navigating services; difficulty being taken seriously and achieving a diagnosis; disjointed and siloed care (including inability to access specialist services); variation in standards (e.g. inconsistent criteria for seeing, investigating and referring patients); variable quality of the therapeutic relationship (some participants felt well supported while others felt “fobbed off”); and possible critical events (e.g. deterioration after being unable to access services). Emotionally significant aspects of participants’ experiences informed ideas for improving services. Suggested quality principles for a long Covid service include ensuring access to care, reducing burden of illness, taking clinical responsibility and providing continuity of care, multi-disciplinary rehabilitation, evidence-based investigation and management, and further development of the knowledge base and clinical services. NCT04435041.
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影响因子：
3.2
作者：
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通讯作者：
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