{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T06:24:12Z","timestamp":1786947852945,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Health Serv."],"abstract":"<jats:p>\n                    Post-COVID syndrome has emerged as a major public health challenge, yet comprehensive characterization of healthcare utilization patterns and medication burden within single cohorts remains limited. This cross-sectional analysis examined baseline data from 76 patients (49\u2009\u00b1\u200912 years, 62% female) enrolled in a randomized trial of psychosomatic treatment interventions for functional post-COVID syndrome. Participants completed the Health Care Utilization Questionnaire (HCU) assessing physician visits, hospitalizations, alternative healing methods, and other healthcare services over the preceding 12 months. Medication and other preparation (MOP) use was systematically documented and classified using the Anatomical Therapeutic Chemical (ATC) classification system. K-means clustering identified distinct patient phenotypes, and correlations between MOP count and healthcare utilization were examined using Spearman correlation coefficients. Healthcare utilization was universal, with 100% of participants engaging with healthcare services and a mean of 43.5 contacts per year. Medication burden was substantial, with 85.5% taking at least one medication, a mean of 4.57 medications per patient, and polypharmacy (\u22655 MOP, all types) present in 39.5% of the cohort (46.1% of patients with any MOP). K-means clustering identified four distinct patient phenotypes: Low Utilizers (64.5%,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200949), Moderate-High Utilizers (27.6%,\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200921), High-Intensity Users (6.6%), and one outlier. High-Intensity Users demonstrated the most striking profile with 9.60 mean medications, 75.0 total healthcare contacts annually, and mean out-of-pocket costs of \u20ac2,881. MOP count showed significant positive correlations with total doctor visits (\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u2009=\u20090.471,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&amp;lt;\u20090.001), total healthcare contacts (\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u2009=\u20090.344,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.002), and out-of-pocket costs (\n                    <jats:italic>\u03c1<\/jats:italic>\n                    \u2009=\u20090.375,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Post-COVID syndrome patients demonstrate high healthcare engagement, substantial medication burden, and meaningful heterogeneity in utilization patterns. The identification of distinct patient clusters and strong correlations between medication burden and healthcare utilization provide insights for developing targeted clinical management strategies. This study is based on a selected clinical cohort, and findings should be interpreted with caution regarding generalizability to the broader post-COVID population. These findings may inform clinical management strategies and health system planning for post-COVID patients.\n                  <\/jats:p>","DOI":"10.3389\/frhs.2026.1838358","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:36Z","timestamp":1786944336000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare utilization patterns and medication burden in post-COVID syndrome: a cross-sectional analysis reveals four phenotypes"],"prefix":"10.3389","volume":"6","author":[{"given":"Jens","family":"Hamberger","sequence":"first","affiliation":[{"name":"Department of Psychosomatic Medicine, University Clinic Regensburg","place":["Regensburg, Germany"]},{"name":"Department of Applied Natural Sciences and Health, Coburg University of Applied Sciences and Arts","place":["Coburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Kraus","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Meissner","sequence":"additional","affiliation":[{"name":"Department of Applied Natural Sciences and Health, Coburg University of Applied Sciences and Arts","place":["Coburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Hinterberger","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine, University Clinic Regensburg","place":["Regensburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Loew","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine, University Clinic Regensburg","place":["Regensburg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Schoeffski","sequence":"additional","affiliation":[{"name":"School of Business and Economics, Chair of Health Care Management, Friedrich-Alexander University of Erlangen-Nuremberg","place":["Nuremberg, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harald","family":"G\u00fcndel","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steffen","family":"Walter","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc N.","family":"Jarczok","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katja","family":"Weimer","sequence":"additional","affiliation":[{"name":"Department of Psychosomatic Medicine and Psychotherapy, Ulm University Medical Center","place":["Ulm, Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1186\/s13034-024-00787-z","article-title":"Antidepressant treatment initiation among children and adolescents with acute versus long COVID: a large retrospective cohort study","volume":"18","author":"Tran","year":"2024","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"B2","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1038\/s41746-025-01617-y","article-title":"Label efficient phenotyping for long COVID using electronic health records","volume":"8","author":"Hong","year":"2025","journal-title":"NPJ Digit Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1017\/S0950268823001139","article-title":"Identification of post-COVID-19 condition phenotypes, and differences in health-related quality of life and healthcare use: a cluster analysis","volume":"151","author":"Gerritzen","year":"2023","journal-title":"Epidemiol Infect"},{"key":"B4","doi-asserted-by":"publisher","first-page":"2600","DOI":"10.3390\/v14122600","article-title":"A comprehensive report of German nationwide inpatient data on the post-COVID-19 syndrome including annual direct healthcare costs","volume":"14","author":"Walter","year":"2022","journal-title":"Viruses"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e0254523","DOI":"10.1371\/journal.pone.0254523","article-title":"Burden of post-COVID-19 syndrome and implications for healthcare service planning: a population-based cohort study","volume":"16","author":"Menges","year":"2021","journal-title":"PLoS One"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1774115","DOI":"10.3389\/fpubh.2026.1774115","article-title":"German Nationwide inpatient data on the post-COVID-19 syndrome: an update","volume":"14","author":"Walter","year":"2026","journal-title":"Front Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"e2018062","DOI":"10.4178\/epih.e2018062","article-title":"Data resource profile: the national health insurance research database (NHIRD)","volume":"40","author":"Lin","year":"2018","journal-title":"Epidemiol Health"},{"key":"B8","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1186\/s12889-025-21393-4","article-title":"Healthcare utilization patterns before and after a long COVID diagnosis: a case-control study","volume":"25","author":"DeVoss","year":"2025","journal-title":"BMC Public Health"},{"key":"B9","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1177\/01410768241288345","article-title":"Healthcare utilisation of 282,080 individuals with long COVID over two years: a multiple matched control, longitudinal cohort analysis","volume":"117","author":"Mu","year":"2024","journal-title":"J R Soc Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"3782","DOI":"10.3390\/jcm10173782","article-title":"Long COVID: distinction between organ damage and deconditioning","volume":"10","author":"Kersten","year":"2021","journal-title":"J Clin Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1080\/13696998.2025.2485626","article-title":"All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020\u20132023","volume":"28","author":"Yang","year":"2025","journal-title":"J Med Ecom"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2704","DOI":"10.3390\/healthcare13212704","article-title":"Long COVID is associated with excess direct healthcare expenditures among adults in the United States","volume":"13","author":"Neba","year":"2025","journal-title":"Healthcare (Basel)"},{"key":"B13","doi-asserted-by":"publisher","first-page":"00469580251410890","DOI":"10.1177\/00469580251410890","article-title":"Comparison of healthcare expenditures among individuals with and without long COVID in the United States","volume":"63","author":"Duru","year":"2026","journal-title":"Inquiry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12877-017-0621-2","article-title":"What is polypharmacy? A systematic review of definitions","volume":"17","author":"Masnoon","year":"2017","journal-title":"BMC Geriatr"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e0345076","DOI":"10.1371\/journal.pone.0345076","article-title":"Prevalence, predictors, and clinical relevance of drug-drug interactions in outpatient prescribing: a national cross-sectional study","volume":"21","author":"Aarabi","year":"2026","journal-title":"PLoS One"},{"key":"B16","doi-asserted-by":"publisher","first-page":"89","DOI":"10.36150\/2499-6564-N725","article-title":"Addressing medication safety in the elderly: prevalence of potentially inappropriate medications in outpatient geriatrics by beers criteria 2023","volume":"72","author":"Gholamnezhad","year":"2024","journal-title":"J Gerontol Geriatr"},{"key":"B17","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1007\/s00228-013-1639-9","article-title":"Prevalence of polypharmacy in a Scottish primary care population","volume":"70","author":"Payne","year":"2014","journal-title":"Eur J Clin Pharmacol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e42275","DOI":"10.1097\/MD.0000000000042275","article-title":"Traditional Chinese medicine for post-COVID: a retrospective cohort study","volume":"104","author":"Kraft","year":"2025","journal-title":"Medicine (Baltimore)"},{"key":"B19","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1186\/s12888-025-06521-z","article-title":"Uncovering antidepressant prescription patterns: a three-year analysis of outpatient trends","volume":"25","author":"Karami","year":"2025","journal-title":"BMC Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1111\/joim.13584","article-title":"Post COVID-19 condition diagnosis: a population-based cohort study of occurrence, associated factors, and healthcare use by severity of acute infection","volume":"293","author":"Hedberg","year":"2023","journal-title":"J Intern Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1159\/000484413","article-title":"Management of functional somatic syndromes and bodily distress","volume":"87","author":"Henningsen","year":"2018","journal-title":"Psychother Psychosom"},{"key":"B22","doi-asserted-by":"publisher","first-page":"1686494","DOI":"10.3389\/fpsyt.2026.1686494","article-title":"Effectiveness of two interventions to optimize expectations in psychosomatic rehabilitation of post-COVID patients: study protocol for an integrative approach","volume":"17","author":"Wedekind","year":"2026","journal-title":"Front Psychiatry"},{"key":"B23","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1159\/000478028","article-title":"HCU-Q: development of a questionnaire assessing health care utilization","volume":"28","author":"Weiss","year":"2018","journal-title":"Verhaltenstherapie"},{"key":"B24","volume-title":"ATC\/DDD Index 2026","year":"2026"},{"key":"B25","volume-title":"SciSpace AI (Version 2026) [Internet]","year":"2026"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1111\/jgs.70379","article-title":"Association between real-time alerts in electronic prescribing systems and potentially inappropriate prescribing among older adults","volume":"74","author":"Aminzade","year":"2026","journal-title":"J Am Geriatr Soc"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1016\/j.ajic.2024.07.007","article-title":"Antibiotic prescription prevalence in Iranian outpatients: a focus on defined daily doses and the AWaRe classification system","volume":"52","author":"Nasehi","year":"2024","journal-title":"Am J Infect Control"}],"container-title":["Frontiers in Health Services"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1838358\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T05:25:37Z","timestamp":1786944337000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frhs.2026.1838358\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":27,"alternative-id":["10.3389\/frhs.2026.1838358"],"URL":"https:\/\/doi.org\/10.3389\/frhs.2026.1838358","relation":{},"ISSN":["2813-0146"],"issn-type":[{"value":"2813-0146","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]},"article-number":"1838358"}}