Implementation effectiveness of the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP): a multimodal Extension for Community Healthcare Outcomes (ECHO) model for clinician learning

Introduction Long COVID and other infection-associated chronic conditions (IACC) present management challenges for primary care clinicians and often require patient access to multidisciplinary specialists. To strengthen primary care capacity, the Long COVID and Fatiguing Illnesses Recovery Program (LC&FIRP) implemented a multi-modal learning model combining Extension for Community Healthcare Outcomes (ECHO) case-based learning with complementary educational modalities. The ECHO learning component was evaluated for effectiveness in a Type II hybrid design randomized control trial, and an implementation evaluation assessed implementation of the full LC&FIRP model to inform future implementation and scale-up. Methods We conducted a qualitatively driven mixed-methods implementation evaluation of the LC&FIRP model, assessing acceptability, feasibility, fidelity, sustainability, and scalability. Participants comprised clinicians from a federally qualified health center serving predominantly uninsured, low-income, and medically underserved patients in San Diego, CA. All trial clinicians were offered monthly webinars and quarterly asynchronous online short courses; intervention clinicians were additionally offered weekly ECHO sessions. Data sources were session surveys at the end of every session or short-course, quarterly clinician follow-up surveys, and interviews with participants, subject matter experts (SMEs) and clinic administrators at program end. Results Acceptability findings reflected high clinician satisfaction and perceived utility of the weekly and monthly offerings but moderate sustained engagement and negligible participation in the quarterly short courses. Clinicians valued most the interactive peer exchange; practical diagnostic and treatment approaches; and lessons from SMEs with lived experience. Feasibility barriers included competing clinical and administrative demands and the time commitment required for participation. Most program components were implemented with fidelity but fewer weekly ECHO sessions and case presentations were delivered than planned. Sustainability and scalability showed early promise with the continuation of weekly and monthly offerings after trial end, but future barriers remain. Discussion This study demonstrates that a multi-modal program combining ECHO case-based learning with complementary educational offerings may be feasibly implemented and is acceptable to clinicians for supporting primary care management of complex chronic conditions, although sustaining engagement and scaling the model will require adaptations to reduce participation burden and resource requirements.