Living With Covid Recovery app allows Trusts to target care and gives Long Covid patients ongoing clinician support: An interview with Hannah Hylton

Summary

Hannah Hylton is a highly specialised respiratory physiotherapist at Barts Health NHS Trust. During the first wave of the Covid-19 pandemic, she was part of the team that designed the Trust’s after-Covid services, including the Living With Covid Recovery app.

In this interview, Hannah explains how the app works and how it is being used by Trusts around the UK to support over 1,500 patients living with Long Covid.

Questions & Answers

Hi Hannah. Firstly, can you explain why your team decided to develop an app?

We recognised early on in the Covid-19 pandemic that there would be large numbers of patients who needed follow up due to ongoing Covid symptoms, now known as Long Covid. We realised that with targeted education and advice, many patients would be able to manage their symptoms and recovery at home. For others, this would need to be combined with face-to-face input from therapies or medical teams. To help facilitate this approach, we developed the Living With Covid Recovery App, an NIHR project devised by experts from UCL Partners, Barts Health and app developer Living With.

How does the Living With Covid Recovery app work?

At Barts, we invite patients to use the app when they attend our Long Covid clinic, having been referred to the clinic on discharge from hospital or by their GP. We have developed a pathway to ensure the programme is the right fit for patients.

The app provides patients with a comprehensive library of information about a range of Long Covid symptoms and ways to deal with them. Patients can also record their symptoms and complete questionnaires in the app, which then feed into a clinician-monitored dashboard. From the dashboard, we can review and track patient progress, allowing us to tailor support to each patient. We point patients to specific treatments on the app to help with the symptoms they have reported, such as breathlessness. There is also a two-way message function that allows patients to ask questions and share concerns, and healthcare professionals to provide support and encouragement.

How does the app help patients with Long Covid get help and support?

The app offers a different pathway to traditional, solely face-to-face clinics. It allows patients to send us messages at any time so they don’t have to wait until their next appointment to ask for help. Many patients will have further face-to-face appointments, but this is not always necessary.

Rehabilitation takes time and the app offers people a tool to map their own progress, knowing they have access to professional support and tailored guidance. It helps patients feel safe, knowing they have a ‘foot in the clinic door’ and the ear of a clinician.

What problems has the app helped overcome and how has it improved patient safety?

At the point when patients needing post-Covid follow up entered the NHS systems, our centres were stretched and in some cases overwhelmed. We needed to introduce processes that would allow us to treat more patients in a safe way. The app enables large numbers of patients to be followed up by a small number of clinicians. It takes 2-3 minutes for a clinician to review a patient's weekly input on the app and send them a short, personal message, but that input can be hugely valuable for the patient.

The app doesn’t replace face-to-face consultations - we continue to offer clinic appointments to patients who need them. In fact, the app enables us to more easily identify patients who need to see us in person. Another benefit is that the app tracks each patient’s progress through their rehabilitation and allows us to monitor them over a longer period of time. It provides us with a consistent stream of information rather than the snapshots in time that we see in traditional clinic settings.

How have you built patient safety measures into the app?

We are very clear with patients about what the app is designed to do. The app itself clearly states that it is not an emergency health care service and reminds patients to follow correct urgent care channels if they need to.

In many cases we have signed patients up to the app while they are in clinic so that we can offer support as they get set up. For other patients, we have provided telephone or email support and most people have had no issues getting started. Once they are signed up, we can use the messaging function to prompt them to use the app to its full potential. For example, we might link them to advice on symptoms they are recording or request they complete questionnaires that are relevant to concerns they have raised. We are making iterative changes to the app as we learn more about Long Covid, how to treat it and what support is more useful for patients.

What feedback have you had from patients and staff?

Trusts across the country have had to rapidly set-up Long Covid services, often with high demand and limited staff. The feedback from the 18 Trusts using the app to support this has been very positive, as it allows them to streamline their patient support effectively. As clinicians, the app enables us to safely manage larger numbers of patients than we could at in-person clinics, and to appropriately identify those in need of further face-to-face sessions. 

From the beginning, we have seen patients as a key partner in developing the app, alongside clinical specialists and researchers. We recruited a patient public involvement group (PPI) that works alongside the development team to give patient perspectives on how the app is used and the processes involved. Patients report how well supported they feel knowing someone is checking in and walking their rehabilitation journey with them.

One patient said, "Five months after having Covid, I was still feeling very breathless and easily tired - even walks could frustratingly leave me coughing and wheezing. I started using the Covid Recovery app in August and have found it very helpful in tracking my progress and building up my activity levels. One of the most important aspects for me is the connection to support and advice from my own physiotherapist and doctors through the app, which has helped reassure me and made me feel that I'm not alone."

How can other trusts access the app?

If Trusts are interested in using the Living With Covid Recovery app, they should contact Henry Goodfellow at henry.goodfellow@nhs.net 

We would love to hear from patients using the Covid recovery app - sign up to the hub to comment below or join our Long Covid apps community discussion and share your experience.

Suggested reading

Tackling the care and treatment backlog safely: Part 1
Long Covid: What information do patients and staff need to improve care and understanding?
Innovation and new technology to help reduce NHS waiting lists