STIMULATE-ICP-Delphi (Symptoms, Trajectory, Inequalities and Management: Understanding Long-COVID to Address and Transform Existing Integrated Care Pathways Delphi): Study Protocol.

Abstract

Introduction
As mortality rates from COVID-19 disease fall, the high prevalence of long-term sequelae (Long COVID) is becoming increasingly widespread, challenging healthcare systems globally. Traditional pathways of care for Long Term Conditions (LTCs) have tended to be managed by disease-specific specialties, an approach that has been ineffective in delivering care for patients with multi-morbidity. The multi-system nature of Long COVID and its impact on physical and psychological health demands a more effective model of holistic, integrated care. The evolution of integrated care systems (ICSs) in the UK presents an important opportunity to explore areas of mutual benefit to LTC, multi-morbidity and Long COVID care. There may be benefits in comparing and contrasting ICPs for Long COVID with ICPs for other LTCs.
Methods and analysis
This study aims to evaluate health services requirements for ICPs for Long COVID and their applicability to other LTCs including multi-morbidity and the overlap with medically not yet explained symptoms (MNYES). The study will follow a Delphi design and involve an expert panel of stakeholders including people with lived experience, as well as clinicians with expertise in Long COVID and other LTCs. Study processes will include expert panel and moderator panel meetings, surveys, and interviews. The Delphi process is part of the overall STIMULATE-ICP programme, aimed at improving integrated care for people with Long COVID.
Ethics and dissemination
Ethical approval for this Delphi study has been obtained (Research Governance Board of the University of York) as have approvals for the other STIMULATE-ICP studies. Study outcomes are likely to inform policy for ICPs across LTCs. Results will be disseminated through scientific publication, conference presentation and communications with patients and stakeholders involved in care of other LTCs and Long COVID.
Registration
Researchregistry: https://www.researchregistry.com/browsethe#registry#home/registrationdetails/6246bfeeeaaed6001f08dadc/.
Strengths and limitations of this study
Gap: There is no general model for providing ICPs to many LTCs, especially in case of multi-morbidity or MNYES.
Solution: We will develop policy recommendations for such ICPs based upon a Delphi process exploring the value and interchangeability of elements of ICPs for Long COVID. This will help patients and clinicians navigate access to, or provide ICPs for, LTCs.
Strengths:
A key tenet is that people with lived experience of Long COVID or an LTC will be involved from inception in the design and conduct of the study.
Weaknesses:
Possible under-representation of digitally hard to reach groups, although efforts will be made to ensure that data collection is widely inclusive, following the NIHR INCLUDE framework.