General practice attendances among patients attending a post-COVID-19 clinic: a pilot study

Enhancing the management of long COVID in general practice: a scoping review

Background

Long COVID is a multifaceted condition, and it has impacted a considerable proportion of those with acute-COVID-19. Affected patients often have complex care needs requiring holistic and multidisciplinary care, the kind routinely provided in general practice. However, there is limited evidence regarding GP interventions.

Aim

This study aimed to address this issue by conducting a scoping review of literature on GP management of Long COVID.

Design & setting

Arksey and O’Malley’s six-stage scoping review framework with recommendations by Levac et al. was used.

Method

PubMed, Google Scholar, the Cochrane Library, SCOPUS, and Google searches were conducted to identify relevant peer-reviewed/grey literature, and study selection process was conducted according to the PRISMA Extension for Scoping Reviews guidelines. Braun and Clarke’s ‘Thematic Analysis’ approach was used to interpret data.

Results

Nineteen of 972 identified papers were selected for review. These included peer-reviewed articles and grey literature spanning a wide range of countries. Six themes were identified regarding GP management of Long COVID, these being: (i) GP uncertainty, (ii) Listening and empathy, (iii) Assessment and monitoring of symptoms, (iv) Coordinating access to appropriate services, (v) Facilitating provision of continual and integrated multi-disciplinary care and (vi) Need to facilitate psychological support.

Conclusion

The findings show that GPs can and have played a key role in the management of Long COVID, and that patient care can be improved through better understanding of patient experiences, standardised approaches for symptom identification/treatment, and facilitation of access to multidisciplinary specialist services when needed. Future research evaluating focused GP interventions is needed.

Mental health and alcohol use among patients attending a post-COVID-19 follow-up clinic: a cohort study

Background: Ongoing mental health problems following COVID-19 infection warrant greater examination. This study aimed to investigate psychiatric symptoms and problematic alcohol use among Long COVID patients. Methods: The study was conducted at the Mater Misericordiae University Hospital’s post-COVID-19 follow-up clinic in Dublin, Ireland. A prospective cohort study design was used encompassing assessment of patients’ outcomes at 2-4 months following an initial clinic visit (Time 1), and 7–14-month follow-up (Time 2). Outcomes regarding participants’ demographics, acute COVID-19 healthcare use, mental health, and alcohol use were examined. Results: The baseline sample’s (n = 153) median age = 43.5yrs (females = 105 (68.6%)). Sixty-seven of 153 patients (43.8%) were admitted to hospital with COVID-19, 9/67 (13.4%) were admitted to ICU, and 17/67 (25.4%) were readmitted to hospital following an initial COVID-19 stay. Sixteen of 67 (23.9%) visited a GP within seven days of hospital discharge, and 26/67 (38.8%) did so within 30 days. Seventeen of 153 participants (11.1%) had a pre-existing affective disorder. The prevalence of clinical range depression, anxiety, and PTSD scores at Time 1 and Time 2 (n = 93) ranged from 12.9% (Time 1 anxiety) to 22.6% (Time 1 PTSD). No statistically significant differences were observed between Time 1 and Time 2 depression, anxiety, and PTSD scores. Problematic alcohol use was common at Time 1 (45.5%) and significantly more so at Time 2 (71.8%). Clinical range depression, anxiety, and PTSD scores were significantly more frequent among acute COVID-19 hospital admission and GP attendance (30 days) participants, as well as among participants with lengthy ICU stays, and those with a previous affective disorder diagnosis. Conclusions: Ongoing psychiatric symptoms and problematic alcohol use in Long COVID populations are a concern and these issues may be more common among individuals with severe acute COVID-19 infection and /or pre-existing mental illness.