Patients' evaluation of aftercare following hospitalization for COVID-19: satisfaction and unmet needs

Abstract

Background: Patient experiences with COVID-19 aftercare remain largely unknown. We evaluated COVID-19 aftercare from a patient perspective one year after hospitalization, assessing satisfaction and its associated factors, and unmet needs.

Methods: The Satisfaction with COVID-19 Aftercare Questionnaire (SCAQ) was developed as part of a multicenter prospective cohort study and administered one year after hospital discharge. The SCAQ assesses (1) patient satisfaction, comprising information provision, rehabilitation, follow-up by hospitals and general practitioners (GPs), the most important aftercare topics, and overall satisfaction, and (2) unmet needs.

Results: 487/561 (87%) COVID-19 patients completed the SCAQ, all had been discharged from the hospital between March 2020 and May 2021. Among responders, the median age of patients was 60 (IQR 54-67) years, 338 (69%) were male, and the median length of stay in the hospital was 13 (6-27) days. Patients were least satisfied with information on who could be contacted with questions when health problems arise (59% satisfied or very satisfied). Many patients (75%) received rehabilitation, most frequently community-based (70%). Across the different community-based therapies, ≥ 60% of patients were satisfied with shared-decision making and ≥ 70% with the received therapy; a majority (≥ 79%) indicated a preference for receiving the same therapy again if needed. Regarding follow-up by hospitals, 86% of patients received this follow-up, most frequently visiting a pulmonologist (96%), being generally satisfied with the received aftercare. Aftercare from GPs was received by 39% of patients, with 88% being satisfied with the GP's availability and 79% with referral to appropriate aftercare providers. Patients (> 50%) considered information-related items most important in aftercare. Overall, patients rated their satisfaction with aftercare 8/10 (7-9) points. Those who received medical rehabilitation (versus no rehabilitation, adjusted beta 0.61 [95%CI 0.11 to 1.11], p = 0.02) or aftercare by a hospital medical specialist (1.1 [0.46 to 1.64], p < 0.001) or GP (0.39 [0.053 to 0.72], p = 0.023) reported significantly higher satisfaction than those without such aftercare. Unmet needs were reported by 35% of patients, with lack of information (20%) and lack of additional aftercare and/or involvement of their GP (19%) being the most frequently reported.

Conclusion: Despite the forced quick development of COVID-19 aftercare, patients were generally satisfied. Follow-up by healthcare professionals and information provision is important to meet patients' aftercare needs.

Keywords: Aftercare; COVID-19; Healthcare services; Implementation; Long COVID; Patient satisfaction; Unmet needs.

Fig. 1

Flowchart of study participants. SCAQ: Satisfaction with COVID-19 Aftercare Questionnaire

Fig. 2

Patients’ satisfaction with information provision after hospitalization for COVID-19. Satisfaction with each item was assessed only for patients to whom it applies (self-indicated). Items were applicable to 362 (74%) of 487 patients on nutritional advice, 432 (89%) on information on the recovery period, and 439 (90%) on information on who could be contacted with questions when health problems arise

Fig. 3

Follow-up by the hospital with A: the proportion of 420 COVID-19 patients that visited medical specialists, B: reasons for not participating in this follow-up, and C: patients’ satisfaction with aftercare provided by their medical specialist. A: 420 (86%) patients received follow-up by the hospital, of whom 292 (70%) patients visited one specialist, 77 (18%) two specialists, 33 (8%) three specialists, 14 (3%) four specialists, and 4 (1%) 5 specialists. B: Sixty-seven patients did not receive this follow-up; one example for ‘other reasons’ included ‘follow-up via surveys only.’ C: data are presented for 420 patients who participated in follow-up by the hospital and to whom it applies (self-indicated)

Fig. 4

Forest plot showing predictors of the patients’ overall satisfaction with COVID-19 aftercare. The multivariable generalized estimating equations analysis included 481 patients. Satisfaction was assessed on a numeric scale from 0 to 10. For rehabilitation, patients were categorized according to the most specialized aftercare they had received after hospitalization for COVID-19, with Med- and SNF-rehab being the most specialized. Aftercare by a medical specialist indicates post-discharge follow-up provided by the hospital. Adj. β adjusted beta, CI confidence interval, No-rehab patients who did not receive rehabilitation, Com-rehab community-based rehabilitation, Med-rehab in- or out-patient medical rehabilitation, SNF-rehab inpatient rehabilitation in a skilled nursing facility, GP general practitioner

Fig. 5

Unmet needs of patients recovering from COVID-19. Unmet needs are presented for 485 patients