{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T11:09:23Z","timestamp":1779361763411,"version":"3.51.4"},"reference-count":26,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Expectations"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long Covid (LC) is a multisystem condition leading to a wide range of symptoms and often requiring treatment by several different clinical specialties. Patients with LC have reported difficulties in accessing care and a lack of coordination of their care, particularly in a hospital setting.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the extent to which the intensity and continuity of hospital care changes for patients after they receive an LC diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational cohort study using a linked primary and secondary care dataset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and Participants<\/jats:title>\n                    <jats:p>Routine healthcare data from North West London Integrated Care System of patients with a recorded diagnosis of LC who had attended a secondary care hospital Trust from 1 January 2019 to 30 September 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Variables Studied<\/jats:title>\n                    <jats:p>The intensity of utilisation of secondary care was calculated, and the continuity of care with respect to hospitals and specialties was computed using the sequential continuity score (SeCon) before the Covid\u201019 pandemic, before and after an LC diagnosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>5611 out of 6270 (90.1%) patients diagnosed with LC had a recorded secondary care interaction in the study period. Intensity of secondary care utilisation increased markedly in outpatient, inpatient and Emergency Department pathways after a diagnosis of LC but peaked in the week of diagnosis. Average hospital SeCon fell significantly after an LC diagnosis from 1.00 to 0.83, while specialty SeCon remained unchanged from after diagnosis (0.40) and before the pandemic (0.44). A notable shift in specialty activity was observed with a focus on respiratory medicine as a major hub in a densely connected patient\u2010sharing network with cardiology and other medical and surgical specialties.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>A recorded LC diagnosis was associated with increases in the intensity of hospital activity and a reduction in hospital\u2010level care continuity, but no change in specialty continuity, which remains low.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Collectively, this indicates a significant need to support LC patients as they navigate fragmented secondary care pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patient and Public Contribution<\/jats:title>\n                    <jats:p>This study was co\u2010designed with, conducted with and written in conjunction with people with long Covid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/hex.70527","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T13:18:11Z","timestamp":1770815891000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Exploring the Intensity and Continuity of Hospital Care for Patients With Long Covid: Evidence From an English Urban Healthcare System"],"prefix":"10.1111","volume":"29","author":[{"given":"Jonathan","family":"Clarke","sequence":"first","affiliation":[{"name":"I\u2010X, Imperial College London London UK"},{"name":"Department of Mathematics, Imperial College London Centre for Mathematics of Precision Healthcare London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sneha","family":"Jha","sequence":"additional","affiliation":[{"name":"I\u2010X, Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Denys","family":"Prociuk","sequence":"additional","affiliation":[{"name":"I\u2010X, Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik","family":"Mayer","sequence":"additional","affiliation":[{"name":"I\u2010X, Imperial College London London UK"},{"name":"iCARE Secure Data Environment, Imperial College Healthcare NHS Trust &amp; Faculty of Medicine Imperial College London  UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"de Lusignan","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences University of Oxford Oxford UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nikki","family":"Smith","sequence":"additional","affiliation":[{"name":"Person with Long Covid, Member of the LOCOMOTION Study Patient Advisory Group Windsor UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruairidh","family":"Milne","sequence":"additional","affiliation":[{"name":"Person with Long Covid; and Emeritus Professor of Public Health University of Southampton Southampton UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cassie","family":"Lee","sequence":"additional","affiliation":[{"name":"Imperial College London NHS Trust, Imperial College Respiratory Research Unit (ICRRU) London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes De","family":"Kock","sequence":"additional","affiliation":[{"name":"NHS Highland, COVID Recovery Service Inverness UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manoj","family":"Sivan","sequence":"additional","affiliation":[{"name":"Academic Department of Rehabilitation Medicine University of Leeds Leeds UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brendan C.","family":"Delaney","sequence":"additional","affiliation":[{"name":"I\u2010X, Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"LOCOMOTION Study Consortium","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,2,11]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Overview | COVID\u201019 Rapid Guideline: Managing the Long\u2010Term Effects of COVID\u201019 | Guidance | NICE(2020) https:\/\/www.nice.org.uk\/guidance\/ng188."},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21040473"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-022-01909-w"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-43661-w"},{"key":"e_1_2_13_6_1","unstructured":"Self\u2010Reported Coronavirus (COVID\u201019) Infections and Associated Symptoms England and Scotland\u2014Office for National Statistics https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/articles\/selfreportedcoronaviruscovid19infectionsandassociatedsymptomsenglandandscotland\/november2023tomarch2024."},{"key":"e_1_2_13_7_1","unstructured":"Coronavirus\u202f\u00bb Post\u2010COVID Syndrome (Long COVID) https:\/\/www.england.nhs.uk\/coronavirus\/post\u2010covid\u2010syndrome\u2010long\u2010covid\/."},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/jmv.26368"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1258\/135581906778476490"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-021161","article-title":"Continuity of Care With Doctors\u2014A Matter of Life and Death? 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