Assisting GPs in holistic home-based COVID care

‘Caring for patients with COVID-19 in their homes allows the provision of appropriate care, minimises the impact on the healthcare system and frees up hospital beds for patients with moderate or severe illness.’
 
That is Dr Penny Burns, GP and member of the development team for the RACGP’s new Home-care guidelines for adult patients with mild COVID-19.
 
The guidelines identify that people who test positive for COVID-19 are most likely to only experience mild symptoms and recover without requiring special treatment or hospitalisation.
 
Designed to support general practice teams, the guidelines detail information for GPs who are providing home-based care in a private residential home – including public or community housing – for adult patients who have tested positive for COVID-19 and are asymptomatic or have mild symptoms.
 
Dr Burns told newsGP the resource draws heavily on the advice from the National COVID-19 Clinical Evidence Taskforce, for which she sits on the primary care and paediatric panels.
 
‘The taskforce has produced a flowchart of evidence-based advice and, where that may not be available, consensus-based advice, on the management of adults with mild COVID-19,’ she said.
 
Dr Burns says guidance management of mild COVID-positive patients ­­­ is ‘particularly relevant’ for Victorian GPs as the state continues to see high daily infection numbers.
 
‘In other states such as NSW, the local health districts are predominantly managing these home cases through organised teams at the moment, but this could change if their local case numbers surge,’ Dr Burns said.
 
‘[Because] GPs regularly make decisions on when to escalate care and transfer patients to hospital,this resource is intended to be used as a guide to support this clinical decision, alongside any usual resources such as consultation with local emergency department physicians or local infectious disease specialists.’
 
Dr Burns says the resource is also a useful tool in the doctor­–patient relationship, with GPs well situated to assess other comorbidities or medical issues that – regardless of whether they are related to COVID-19.
 
‘GPs already know the patient and have an existing relationship and level of trust with the patient,’ she said.
 
‘They understand the individual patient’s context and their comorbidities and pre-existing medical needs. These may all have an influence on how quickly care is escalated and also ensures their usual care is not forgotten while the focus may be on COVID.’
 
The expansion of telehealth to support healthcare delivery is one of the many changes GPs have recently faced.
 
Given managing patients by telehealth can ‘present challenges’, Dr Burns says the resource provides guidance on initial assessment for appropriateness of home-based care, as well as an outline for a plan of management, and suggested questions for ongoing monitoring of the patient’s clinical condition, with red flags for escalation if symptoms suggestive of more severe infection develop.
 
During this pandemic GPs are being continually asked to adopt new ways of patient care,’ Dr Burns said.
 
‘GPs have shown their ability to be adaptable and flexible in their healthcare delivery yet again, as many also demonstrated during the recent bushfire disaster.
 
‘Management of mild COVID-positive patients in the community is well within the unusual remit of GPs, and in any disaster the aim is to continue usual business by usual healthcare providers as much as possible.
 
‘Management of home-based mild COVID-19 cases by the usual local GP provides the opportunity to ensure holistic care of the patient’s physical and mental health while also managing their COVID-19 and is a key role for GPs.’
 
The RACGP’s Home-care guidelines for adult patients with mild COVID-19 is available on the college website.
 
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COVID-19 home care