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Wolf, S. and Erdos, J. (2021): Long COVID care pathways: a systematic review. HTA-Projektbericht 135b.

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Due to the expected growing number of cases and the associated increasing average sick leave durations, long COVID not only places a burden on the patients and their families but also the wider economy, in particular, the workforce. The present systematic review aimed to support preparations and adjustments in the long COVID care planning in Austria by giving (1) an overview of recommendations about long COVID care pathways for adult patients as well as (2) examples of already existing care structures in selected European countries.

A systematic search in four databases and further unsystematic hand searches were conducted. Based on the predefined inclusion criteria, in total 14 references including five guidelines, four reviews, one consensus paper and four clinical perspectives were included for answering both research questions. To answer the second research question, an additional 23 references from further hand searches and expert consultations were considered including websites about patient organisations, healthcare facilities, social care services and a newspaper article about relevant healthcare facilities.

In the included literature, it was recommended that the majority of long COVID-related healthcare should take place in primary care. There are however some differences in the served patient groups between countries. While, for example, in Austria and Germany, all long COVID patients -including former hospitalised and non-hospitalised COVID-19 patients- are advised to consult the general practitioner for a first clinical assessment, in the United Kingdom former hospitalised COVID-19 patients, who suffer from ongoing or new symptoms after 12 weeks of discharge, can attend primary care facilities or secondary care outpatient departments. After the first assessments, patients with more complex symptoms are advised to be referred to so-called specialised long COVID outpatient assessment clinics for further assessments. Some clinics are also intended to offer treatments, such as rehabilitative elements, themselves. Patients with one dominant symptom are recommended to be referred to secondary assessment by the respective specialist. Further options include rehabilitation, community health services and non-medical healthcare providers and are chosen depending on the patients' needs. Furthermore, self-management, such as exercising at home or stress reduction, is recommended as a single therapy for milder long COVID symptoms or as a supporting therapy in addition to other treatments for moderate to severe symptoms. In the United Kingdom, doctors can also refer the patients to a supported self-management online programme "The Your COVID Recovery Platform".

Concerning additional (social) services, the same services as for other (chronic) diseases are also recommended for long COVID patients including support for employees, such as sick leave, phased return or transitional allowance.

Overall, multidisciplinarity, a personalised approach and shared decision-making have been named as key factors for successful long COVID care. For that matter, good communication between healthcare professionals and the patients, including inclusive communication (e.g. by offering translated materials) and the right balance in the detail of provided information to avoid unnecessary uncertainty, is crucial.

Item Type:Project Report
Keywords:Long COVID, recommendations, care pathways, existing care structures, adults
Subjects:W Health professions > W 84 Health services. Quality of health care
WB Practice of medicine > WB 300-962 Therapeutics
WC Communicable diseases
WF Respiratory system
WG Cardiovascular system
WL Nervous system > WL 700-710 Sense organs
WM Psychiatry
Series Name:HTA-Projektbericht 135b
Deposited on:08 Nov 2021 11:36
Last Modified:15 Nov 2021 12:41

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