Use of Long COVID Clinics in the Veterans Health Administration: Implications for the path forward
How widely are Long COVID Clinics (LCCs) being used in the Veterans Health Administration (VHA) system, and are there differences in who has access to and uses these specialized clinics?
College of Health researcher(s)
Abstract
Long COVID is a serious chronic illness that can present in many forms and impact daily functioning and quality of life. Without curative treatments, management of long COVID requires coordination and ongoing access to multidisciplinary care. Starting in 2020, the Veterans Health Administration (VHA), established a national network of Long COVID Clinics (LCCs). In this retrospective cohort study of 494 547 veterans with documented SARS-CoV-2 infection in the VHA from March 2020 to April 2022 (n = 494 547), we examined trends in ICD-10 U09.9 diagnosis code use for long COVID and LCC use in the VHA up to May 2024. Overall, 5.9% (n = 29 195) of patients in our cohort had a documented U09.9 code and 2% had at least 1 LCC visit. Among veterans with a U09.9 code, 17.4% (n = 5089) used LCCs. LCC use rates were low across all patient subgroups. LCCs were more available to veterans residing in the South census region (28% vs <7% use rate) than veterans in other regions. Developing evidence about LCC effectiveness and ensuring equitable access to LCCs within and beyond the VHA will be critical in meeting the evolving needs of people with long COVID.
Long COVID and Veterans FAQ
What is long COVID and how does it affect veterans?
Long COVID is a serious, chronic illness resulting from SARS-CoV-2 infection, characterized by persistent symptoms affecting multiple body systems. It can significantly impact a veteran's daily functioning and quality of life. The symptoms can range from mild to severe and may include chronic fatigue, post-exertional malaise, cognitive impairments, and autonomic dysfunction. These persistent issues are the primary reasons veterans seek care, often leading to the establishment of specialized Long COVID Clinics (LCCs).
What is the Veterans Health Administration's (VHA) approach to long COVID care?
Recognizing the ongoing health needs of veterans with long COVID, the VHA began establishing a national network of LCCs in 2020. These clinics aim to provide coordinated, multidisciplinary care to manage symptoms and improve functional ability, as there are currently no curative treatments for the condition.
How prevalent is long COVID among veterans in the VHA system?
In a study of nearly 500,000 veterans with documented SARS-CoV-2 infection in the VHA between March 2020 and April 2022, approximately 6% received an ICD-10 U09.9 diagnosis code for long COVID between October 2021 and May 2024. This indicates that a significant number of veterans within the VHA have been diagnosed with this condition.
How widely are Long COVID Clinics (LCCs) used by veterans with long COVID?
Overall LCC use among the studied cohort was low, with only 2% of all veterans with documented SARS-CoV-2 infection having at least one LCC visit. Even among veterans with a documented U09.9 long COVID code, only about 17.4% had at least one LCC visit. This suggests that the majority of veterans diagnosed with long COVID in the VHA are not utilizing these specialized clinics.
Are there disparities in LCC use among different veteran subgroups?
Yes, there are notable disparities in LCC use. While older veterans and those with more pre-existing health conditions had higher rates of long COVID diagnosis (U09.9 code), LCC use rates actually declined with age and poorer health. Conversely, LCC users among those with a U09.9 code were younger, more likely to be female and Hispanic, and tended to have lower comorbidity scores. There were also significant regional disparities, with veterans in the South census region having a substantially higher LCC use rate compared to other regions.
What are some potential reasons for the low utilization and regional disparities in LCC access?
Several factors may contribute to the low LCC utilization and regional variations. LCCs are still emerging within the VHA and may not be equally available in all areas. Administrative coding issues might also lead to an undercount of LCC visits. Furthermore, the multidisciplinary teams in LCCs are often located in urban areas, potentially leaving veterans in rural areas underserved. While telehealth and hub-and-spoke models are being explored, their effectiveness in reaching rural areas is still being evaluated. The requirement for referrals to LCCs may also be a barrier for some veterans.
How do the characteristics of veterans who use LCCs differ from those who don't?
Among veterans with a long COVID diagnosis code, those who used LCCs were, on average, younger and more likely to be female and Hispanic. They also tended to be healthier, with lower Care Assessment Needs (CAN) scores and fewer pre-existing conditions like chronic kidney disease and coronary heart disease. However, LCC users had a higher prevalence of mental health conditions like major depression and post-traumatic stress disorder. Geographically, LCC users were more likely to reside in urban areas and predominantly in the South census region.
What are the future implications and needs regarding long COVID care in the VHA?
Given the ongoing nature of the pandemic and the lack of curative treatments for long COVID, the study highlights the critical need for further resources and interventions to ensure equitable access to LCCs. There is a need for greater understanding of the accessibility and effectiveness of various LCC care models, including those utilizing telehealth and hub-and-spoke structures. Further research is also needed to evaluate the effectiveness of LCCs on patient outcomes and to inform policies for expanding access. The VHA and similar health systems could also serve as important platforms for researching and evaluating new therapies for long COVID.