Campos Claudia L, Nguyen Cristina, Crothers Kristina, Awan Omar, Miller Francis J, Sedillo Courtney, Vachachira Johnson, May Carrie B, Gustavson Allison M, Lindheimer Jacob B
W.G. (Bill) Hefner Salisbury Department of Veterans Affairs Medical Center, Salisbury, NC.
Wake Forest University School of Medicine, Department of Internal Medicine, Winston Salem, NC.
J Clin Pathw. 2023;9(1):22-28. doi: 10.25270/jcp.2023.01.02.
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.
美国退伍军人健康事务部（VHA）已在美国各地开设了22家多专科新冠后诊所，以应对越来越多在急性新冠感染后出现长期后遗症的退伍军人。虽然针对该综合征的循证治疗正在研究中，但迫切需要根据这些诊所积累的知识和经验来建立和传播临床路径（CPW）。这份VHA临床路径旨在指导基层医疗临床医生护理新冠后综合征（PCS）期间出现呼吸困难和/或咳嗽的患者，该综合征包括急性新冠发病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VHA系统内退伍军人的护理，改善健康结果，并有效利用医疗资源。本文总结了我们对基层医疗中出现PCS呼吸困难和/或咳嗽患者的逐步诊断方法；还强调了远程会诊和远程康复，认为这是接触农村地区患者或有交通障碍患者的机会，也是改善专科服务可及性的机会。
