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Long COVID education should be part of CPD: Report

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Education to help GPs diagnose and treat long COVID should be part of Continuing Professional Development (CPD), the committee overseeing an inquiry into the condition has said.
 
The proposal is among the recommendations put forward by the Standing Committee on Health, Aged Care and Sport, which released its report into long COVID and repeated COVID infections on Monday.
 
It also called for a review of the MBS chronic disease management item and suggests that most support for the conditions is likely to come from primary care, particularly GPs.
 
In its submission to the inquiry, the RACGP said that chronic disease GP Management Plans (GPMPs) could help manage long COVID.
 
However, it also said the item’s stipulation that a medical condition needs to be present for at least six months is ‘causing hesitancy’ among GPs and ‘reducing patient access to early, subsidised and coordinated multidisciplinary care, and the opportunity to reduce the burden of disease’.
 
The inquiry, which was chaired by Dr Mike Freelander, a paediatrician turned MP, received feedback from hundreds of individuals as well as input from patient and health organisations.
 
Immediately following the release of the report, Federal Health and Aged Care Minister Mark Butler announced $50 million from the Medical Research Future Fund (MRFF) for long COVID research, with grant applications to open in August.   
 
He also confirmed the development of a national plan for long COVID that will take the committee’s findings into consideration.
 
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, who made a personal appearance in front of the committee in February, has welcomed the emphasis on general practice as well as the commitment to more research.
 
‘It is pleasing that the report acknowledged the essential role of GPs and the challenges faced by GPs managing long COVID,’ he told newsGP.
 
However, Professor Morgan believes more action is needed to address the current, ongoing impact.
 
‘I would like to see some immediate options for patients suffering distress and disability now,’ he said.
 
‘GPMPs, team care arrangements and case conferencing patient rebates could all be made available without waiting for national plans and outcomes of Australian research.’
 
RACGP President Dr Nicole Higgins also believes that more should be done to help patients already struggling with the condition.
 
‘It’s disappointing the report doesn’t recommend immediate measures for people suffering distress and disability from long COVID,’ she said.
 
‘Patients’ Medicare rebates don’t adequately support people with long COVID. It’s a complex chronic condition and it requires more of a GPs’ time, but the current patient rebates penalise GPs for spending longer with patients.
 
‘The RACGP is continuing to call on the Federal Government to increase patient rebates for longer consultations to ensure people with complex conditions, including long COVID, can get the care they need.’
 
In its 239-page report, the committee states that emerging evidence suggests most people with long COVID will recover, and that ‘only a minority’ of patients will require specialist care.
 
‘It is clear that long COVID is a significant problem and estimates vary, indicating that between 2–20% of those infected with COVID-19 may develop long COVID,’ it states.
 
‘Even if it is the lower figure of 2%, this is still many people requiring help and support.’
 
It also acknowledges a need for long COVID clinics for patients with severe symptoms but warns of ‘bottlenecks’ if they are placed in hospitals.
 
‘Consequently, the committee considers that these long COVID clinics should be limited in number, to provide care [via telehealth or in person] to triaged patients, while minimising the impacts of these clinics on the broader health workforce,’ the report states.


Professor Mark Morgan

According to the report, the suggested specialist long COVID clinics should engage in research as well as conduct education outreach activities to share their knowledge and expertise.
 
In broad terms, the measures proposed to support primary care include:

• support and education for GPs and other primary healthcare providers to diagnose long COVID and manage patients
• the development of living guidelines co-designed with patients
• support for multidisciplinary long COVID clinics across Australia, as a tertiary referral pathway
• support for the establishment of outreach long COVID clinics for rural and regional areas
• provision of mental health support for people with long COVID
• leveraging of telehealth and digital health resources to help people with long COVID self-manage and access primary care.

The report authors also write that a single COVID-19 database should be administered by a new Centre for Disease Control (CDC) to help develop a broader understanding of long COVID’s impact.
 
The proposed CDC, which was among the current Government’s election commitments, should have a particular focus on high-risk populations, the committee suggests.
 
Professor Morgan believes the National Clinical Evidence Taskforce, in which he participates, should have a role in keeping track of emerging research with implications for care.
 
‘Research and data infrastructure will be important moving forwards, but I would also like to ensure ongoing support for the National Clinical Evidence Taskforce to collate, analyse and synthesise emerging world evidence,’ he said.
 
‘No individual doctor or even long COVID clinic team can match the expertise of the [Taskforce] to maintain a living guideline. ‘
 
Professor Morgan has previously been critical of the Government decision to remove funding for the organisation.
 
Noting the variation in definitions of long COVID, the committee describes the one used by the World Health Organization (WHO) as the as the ‘most useful’ clinically but says this should be subject to review as more information becomes available.
 
According to the WHO definition, long COVID can be diagnosed if symptoms have continued for three months after initial infection.
 
Professor Morgan told the committee that patients with ongoing symptoms after four weeks could be a ‘more practical’ benchmark to give an opportunity for earlier intervention.  
 
The committee also said antiviral treatments should be approached as a ‘pharmacist-initiated medication’ to participants eligible under the PBS.
 
Other recommendations, which the report acknowledges are outside of the scope of the inquiry, include a suggestion to hold a ‘comprehensive summit’ looking into Australia’s response to the pandemic.
 
The committee also says funding should be made available for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) research and patient support.
 
The report acknowledges a ‘possible overlap’ in symptoms by people living with ME/CFS and long COVID, but states the committee’s belief that long COVID is ‘a separate issue’.
 
GPs can find the RACGP’s ‘Caring for adult patients with post−COVID-19 conditions’ guidelines on the college website.
 
Advice is also available for patients on managing post-COVID-19 symptoms at home.
 
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Dr Mike Freelander Long COVID Quality Care

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