The purpose of this project is to address health disparities in the care of patients with post-acute COVID
syndrome (PACS) due to the rural nature of northern New England and its shortage of medical services. We
will develop useful, understandable and relatable information for patients and providers, in partnership with
rural and biomedical libraries. The foundation for our project is the Dartmouth-Hitchcock PACS Clinic, an
established, comprehensive clinic serving patients in Vermont and New Hampshire.
The rural nature of northern New England poses a challenge to delivery of comprehensive care to PACS
patients. Most parts of VT and NH are characterized as being “small town/isolated rural” or “large rural
town.” The debilitating nature of PACS threatens job security, financial stability, and the ability to function
normally, and there is limited access to primary care, physical therapy, occupational therapy, and mental
health services that can accept and are familiar with the complex nature of PACS. Furthermore, the Area
Deprivation Index (ADI), based on a measure created by HRSA, shows that at least half of the two states have
ADI scores of >50, indicating that they are “disadvantaged” in relation to national standards. A large
percentage of the 1300 patients referred to our PACS clinic report difficulties in accessing reliable information
about managing their condition and finding locally based services. Affordable, high-speed internet service is
often limited in rural settings, and many rely on local libraries to meet those needs. Above all, patients express
a sense of isolation, both physical and emotional. Our experience has taught us that bridging that sense of
isolation is often the greatest service we can provide.
Our goal is to “reach more people in more ways through enhanced engagement pathways.” Our aims are:
To improve the care of patients with PACS in rural VT and NH by disseminating useful, usable, and
understandable information to this health-disparity population.
To promote a better understanding of PACS for patients and providers by means of new, appropriately
targeted resources. We will create an online archive of “digital stories” that highlight lived experiences
of patients with PACS and create an independent website and monthly newsletter with content about
PACS that is responsive to the emerging science and meets the needs of our patients and providers.
To raise awareness about PACS in rural communities and promote community access to information
about PACS and post-COVID care.
We will partner with rural libraries, which are often a primary hub of information-sharing in rural
communities, to assist in deploying computer and information technology that is otherwise unavailable or
difficult to use for many of our patients. We will tailor information to meet the needs of our population. Our
efforts should be generalizable to other rural communities in the US.
