Comprehensive Long COVID Care for Underserved Communities: Innovative Delivery and Dissemination Models (Comunidad)

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ABSTRACT Long COVID specialty clinics, some with a multidisciplinary staff, have emerged in various locations, but comprehensive, coordinated care is not readily accessible to many with Long COVID. The Post-COVID-19 Recovery Clinic at UT Health San Antonio serves not only San Antonio, the seventh largest city in the US, but also the largely rural and Hispanic/Latino population of South Texas, a population beset by health disparities. And yet, a major challenge in our current model is the 5-month wait for a new patient appointment and the additional delay to see medical specialists and mental health providers. Further, given our patient population’s many adverse social determinants of health and limited access to care, ready availability of social workers is critical but currently limited. Within our patients’ local communities, there is also a shortage of primary care providers available and knowledgeable about diagnosing, evaluating, and managing people with Long COVID. Moreover, there is a lack of awareness about Long COVID and rife misinformation and disinformation among community members in our vast South Texas catchment area. To improve and expand Long COVID care in San Antonio and South Texas, and to test new, sustainable models of care, we propose to conduct the Comprehensive Long COVID Care for Underserved Communities: Innovative Delivery and Dissemination Models (COMUNIDAD) project, a 5-year program with 3 aims: Aim 1: To expand holistic, multidisciplinary care at UT Health San Antonio. Together with patient and community representatives, we will develop evidence-based, symptom-specific best practices for evaluation, treatment, and self-care. Clinical services and, as appropriate, research study referrals, will be coordinated by a full-time nurse clinical coordinator and care will be provided by a multidisciplinary team. To expand the workforce, we will offer clinical rotations for health professional trainees. Aim 2: To collaborate with community providers on best practices for basic Long COVID evaluation and management. Utilizing Project ECHO and other telementoring modalities, we will disseminate information among clinicians in South Texas rural clinics on conducting a 15-minute, low-tech evaluation of patients presenting with Long COVID symptoms. Care can then be managed locally or referred to the UT Health Long COVID clinic. Aim 3: To partner with the community to disseminate up-to-date information about Long COVID among the largely Hispanic/Latino, rural South Texas communities. Based on community preferences, we will utilize community health workers, mobile apps, social media platforms, and other communication avenues in English and Spanish to increase health literacy and teach the community about Long COVID and accessing care. We anticipate participating actively in the AHRQ learning community to incorporate up-to-date evidence- based care and share information on models of care with other Long COVID centers. If adopted nationally, models such as COMUNIDAD will greatly improve care for persons with Long COVID.