Long-COVID diagnosis may prompt patients to switch from acute to outpatient care

COVID-19
Long-COVID patient in waiting room

Drazen Zigic / iStock

After a diagnosis of long COVID, patients in Colorado shifted from seeking care in hospitals and emergency departments (EDs) to outpatient and specialist visits, with a sharp rise in new prescriptions, suggesting that the diagnosis leads to improved patient care, although healthcare use in this group is still high.

These findings, from a University of Colorado (UC) case-control study, were published this week in BMC Public Health.

The retrospective, longitudinal study used the Colorado's All-Payer Claims Database to identify adults diagnosed as having long COVID and matched controls without the condition from October 2021 to August 2022, with a 1-year follow-up. 

"Understanding these utilization patterns can help policymakers and healthcare providers allocate resources effectively and design interventions that address the unique needs of Long COVID patients," lead author and doctoral student Rick Devoss, MPH, said in a UC press release.

Specialist visits, new prescriptions climb

During the study period, 26,358 of 3.9 million adults had ever received a long-COVID diagnosis, for a prevalence of 0.67% among the population at large. Of these adults, 12,698 were eligible for inclusion. The average age was 59.0 years, 65.3% were women, 60.1% were White, and 83.0% lived in an urban area. Long-COVID patients were matched with 25,376 controls.

Before diagnosis, 17% of long-COVID patients were hospitalized at least once, and 40% had one or more ED visits. On average, these patients saw at least three specialists pre-diagnosis, excluding those seen during a hospitalization, and used nine different drugs. In the year post-diagnosis, the use of hospitalizations and ED visits declined significantly compared with controls (-6.1 and -7.7 percentage points, respectively). 

Quality of life and productivity suffer, and like similar conditions hard to diagnose, patients go from doctor to doctor or the emergency department to find relief and answers.

Marcelo Perraillon, PhD

At the same time, outpatient services and new prescriptions rose (3.6, 4.7, and 5.2 percentage points for office visits, specialist visits, and prescriptions, respectively), compared with controls (2.8 percentage points). In total, 45% of long-COVID patients filled a new antibiotic prescription, and 34.3% filled a new pain prescription. Prednisone was the most commonly filled drug among long-COVID patients (37.8%), compared with 13.7% of controls. 

Before diagnosis, the most common reasons to seek care were exposure to an infectious disease, COVID-19, respiratory signs and symptoms, abnormal findings of the lungs or blood chemistry, and musculoskeletal pain. Compared with controls, long-COVID patients had statistically significant increases in COVID-19 diagnoses, malaise and fatigue, sleep/wake conditions, and respiratory symptoms but significantly lower rates of pneumonia, fluid and electrolyte conditions, and respiratory failure. 

Senior author Marcelo Perraillon, PhD, noted that long COVID is disabling and can lead to psychological scars. "If you are fatigued, in pain, and cannot sleep, it's very hard to function," he said in the release. "Quality of life and productivity suffer, and like similar conditions hard to diagnose, patients go from doctor to doctor or the emergency department to find relief and answers. Some also get the additional diagnosis of chronic fatigue syndrome."

Could save money by avoiding costly acute-care services

Of note, over 70% of long-COVID patients had some form of pain both before and after diagnosis, and 24% experienced respiratory failure, insufficiency, or cardiac arrest before diagnosis. Relative to controls, diagnoses of myalgic encephalomyelitis/chronic fatigue syndrome in long-COVID patients climbed 5 percentage points post-diagnosis.

"The reductions in inpatient and ED utilization suggest that identification and diagnosis of LC [long-COVID] may provide patients with medical management that avoids costly ED and in-patient services," the study authors wrote. "However, it can also represent a slowdown in the acute phase of COVID-19 or LC and eventual recovery."

Possible explanations for the drop in hospitalizations include a decline in long-COVID severity over time and more severe acute infections that led to a higher rate of pre-diagnosis hospitalizations, the authors said. 

"However, our study timeline included a period during which high virulence variants remained widespread," they wrote. "Increasing vaccination rates during the study period may have also contributed to declines in LC severity."

The results suggest that diagnosis could lead to better disease management, the researchers said, yet "healthcare utilization among these patients is high, underscoring the need to understand the Long COVID burden on healthcare systems with population-level data."

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