Bath and North East Somerset, Swindon and Wiltshire Health & Care Long Covid Assessment and Rehabilitation Clinic

The BSW Long covid Assessment Clinic is a unique service delivered by a local team at Wiltshire Health and Care that serve the wider region.

Wiltshire adopted ELAROS’ platform in April 2022 to digitally streamline its large clinical pathway which includes an initial assessment clinic responsible for the initial screening and subsequent triaging of patients to one or more dedicated rehabilitation teams, spanning employment support, occupational therapy, psychological support, respiratory physiotherapy and more.

Each service has a core battery of PROMs which includes the C19-YRSm, EQ-5D-5L, GAD-7, PHQ-9, and the SSEQ at pre-assessment and at 6 months only. The SSEQ is a new PROM adapted from the Pain Self-Efficacy Scale with permission from the authors to adapt, validate and publish research using the new scale.

By screening patients at scale across a range of symptoms, clinicians are able to effectively signpost and refer patients onwards to the most appropriate care teams where they will access support up until the point they are discharged.

Clinical teams can send symptom-specific or tailored support resources directly through the app, such as easy-read guides, exercises and videos, providing more relevant, personalised care to the patient.

The Pathway

Wiltshire is a unique example, in that this team also remotely monitors patients post-discharge to see how patients recover or potentially relapse and may need to re-enter the service and expedite the regular waiting list.

By appropriately advising patients on what to expect following discharge to manage expectations in the event of a relapse and where to find support, the clinical team is able to safely monitor their patients in the community and evaluate longer-term outcomes with appropriate consent from patients.

Outcomes:

  • 94% of patients return complete digital assessments, compared to 60% completion on paper prior to adopting the digital tool
  • Streamlined virtual clinical pathways, organised by individual patient needs
  • Customisable PROMs across the service
  • Comprehensive longitudinal dataset that can be merged with SystmOne data for service evaluation
  • Rapid deployment of new pilot studies to expand the service and support other conditions
“ The introduction of the Elaros app and web portal was crucial in enabling us to realise our vision of a large scale service evaluation. In the most part patients find it easy to use, staff have easily adopted it as part of their day-to-day clinical work, using it to give insights into the patients before contacting them, enabling the clinicians to discuss the main issues for the person and establish what matters to them, without having to spend time on areas self-reported to be no problem.”
Jane Clarke
BSW Long Covid Clinical Pathway Co-ordinator
WHC Clinical Specialist Physiotherapist

BSW and University of the West of England Service Evaluation

Future Plans:

BSW is now focusing on evolving the Long Covid service to explore if the assessment and rehab model can produce the same impact with people with other long term conditions. In addition they are looking to tackle health inequalities through two pilots supported at ELAROS:

  1. Your Health Your Way: a healthcare project that aims to work with socially deprived people with avoidable long term conditions as measured by the Cambridge Multi-morbidity score segment 4. The project invites people to work with the team to enable them to learn more about how to manage the impact of their health symptoms on their life. Through the team’s experience of offering tailored, timely, individual support they understand that everyone’s path to making changes is different. They dedicate time to listen and together work on what matters to you. They offer 3-6 appointments usually over a 3–4-month period, this is offered virtually with option for face to face at times.
  2. Wiltshire Health & Care Long Term Condition Pathway is working with people with Long Covid, respiratory conditions such as COPD, Heart failure and Diabetes to offer then early access contact with clinical teams and signposting to self-management resources to improve people’s ability to self-manage and develop an understanding and commitment to manage their conditions.