Psychiatrists and psychologists at The Ohio State University Wexner Medical Center are launching a Buckeye CARES (COVID-19 Aftercare Recovery and Engagement Service) screening and intervention program to identify and address cognitive and emotional aftereffects of severe COVID-19.
The screening is designed to detect problems with brain function, which may continue after most other COVID-19 symptoms have resolved. In a number of cases, encephalopathy, delirium, anxiety, depression, confusion and other cognitive issues have developed in connection with severe COVID-19.
“People don’t remember where they are or what year it is. They can become lethargic or catatonic,” says psychiatrist Kevin Johns, MD, at the Ohio State Wexner Medical Center. He estimates that he and four of his colleagues have been consulted to provide emotional and cognitive evaluations on more than 100 patients hospitalized with severe COVID-19 from spring through fall 2020.
Dr. Johns says patients also may experience feelings of isolation and loneliness during a hospital stay. Restricted visiting and staff heavily masked and gowned to protect themselves from the virus contribute to these feelings.
How the screening works
Buckeye CARES is part of a larger effort to adopt the Collaborative Care Model at the medical center to integrate behavioral health into primary care and medical oncology.
“The primary care provider is the leader of the care team,” Dr. Johns says. “My goal is to advise and coach providers on handling depression and anxiety and referring on for issues that require ongoing care. We want to combine physical and mental health care in one package to help patients recover as quickly as they can.”
Within two business days of a patient’s discharge from the hospital following care for severe COVID-19, a screener from the Buckeye CARES program – nurse, social worker or pharmacist – schedules a call or video visit with the patient. The screener asks questions designed to uncover delirium, encephalopathy, memory issues or brain fog, depression, anxiety, post-traumatic stress disorder or other cognitive/behavioral issues.
If a patient screens positive for any of these COVID-19 aftereffects, the screener alerts the primary care provider and helps facilitate a referral for a variety of behavioral health interventions, including neuropsychological testing, counseling and medications. A behavioral health care manager will maintain regular contact with the patient, the primary care provider and a consulting psychiatrist to help carry out a comprehensive treatment plan.
The screening also is available to patients who continue to have lingering cognitive effects from COVID-19 weeks or months after other symptoms have disappeared.
Buckeye CARES is funded through a combination of insurance coverage and grants.