Baseline Clinician Attitudes and Practices Regarding Long-Term Neurological Follow-Up for COVID-19 Patients: Early Pandemic Insights With Contemporary Relevance

TL;DR

This study explores how clinicians in early 2020 viewed and handled long-term neurological care for COVID-19 patients, highlighting a gap between their beliefs and actual practices.

Contribution

The study provides early insights into clinician attitudes and practices regarding long-term neurological follow-up for COVID-19 before formal long COVID guidelines existed.

Findings

Most clinicians believed many patients needed long-term neurological follow-up, but few actually referred them.

Referral rates for neurological care increased only slightly during the pandemic.

Many clinicians were less familiar with neurological manifestations of COVID-19 compared to general knowledge.

Abstract

Objectives: This study aimed to investigate clinician opinions and practices regarding long-term neurological follow-up for COVID-19 patients during the early pandemic period (June-August 2020), before formal long COVID recognition, and identify the gaps between clinician awareness and clinical practice implementation.

Methods: We conducted a cross-sectional survey of 199 physicians and advanced practice providers (APPs; including nurse practitioners, physician assistants, certified registered nurse anesthetists (CRNAs), and similar roles) across Northwest Ohio and Southeast Michigan healthcare systems (June-August 2020). The survey assessed clinician awareness of long-term neurological risks, screening behaviors, referral practices, and attitudes toward long-term neurological follow-up using an original adaptive questionnaire administered via Qualtrics. Bivariate associations were tested using Pearson’s chi-square and Fisher’s exact test (p ≤ 0.05). This study was approved by the University of Toledo Institutional Review Board (Protocol #300681, exempt status).

Results: Most respondents (54/96, 56.3%) believed that more than 50% of COVID-19 patients should receive long-term neurological follow-up, primarily by neurology specialists (66/134, 49.3%). However, only 13/93 (14.0%) were actively referring more than 50% of their COVID-19 patients for such care. Average referral rates increased modestly from 14.1% pre-pandemic to 19.9% during the pandemic, with 100/130 (76.9%) reporting no change in practices. Self-reported familiarity with neurological manifestations of COVID-19 (114/179, 63.7%) was substantially lower than general COVID-19 familiarity (178/180, 98.9%).

Conclusions: Substantial disconnect existed between clinician beliefs about appropriate care and actual referral practices, revealing infrastructure barriers, including inadequate specialty capacity and lack of standardized protocols. These baseline findings document the state of clinical practice before formal long COVID guidelines were established.

Policy implications: Healthcare systems require enhanced infrastructure for long-term neurological monitoring of COVID-19 survivors, including increased specialty capacity and standardized protocols, informing pandemic preparedness for chronic disease complications.

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