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New ‘living’ clinical guidelines to provide up-to-the-minute coronavirus recommendations

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The world-first guideline recommendations – Caring for people with COVID-19: Supporting Australia’s healthcare professionals with continually updated, evidence-based clinical guidelines – have been developed by the National COVID-19 Clinical Evidence Taskforce (the taskforce) comprised of experts from Australia’s peak health bodies, including the RACGP.
 
Associate Professor Julian Elliott, Head of Clinical Research in the Department of Infectious Diseases at Alfred Hospital and Monash University, and Senior Research Fellow at Cochrane Australia, is Chair of the taskforce.
 
He told newsGP there is urgent need to arm Australia’s healthcare professionals with evidence-based guidance amid the current pandemic.
 
‘What I’m hearing from a lot of my clinical colleagues is that there’s just an overwhelming amount of information and it’s very difficult for people to keep up even in the best of times, let alone how busy everyone is now,’ Associate Professor Elliott said.
 
‘There’s also a sense that there’s a lot of conflicting messages and I think certainly going forward there was a risk that we would have different specialist societies and different groups putting out somewhat different statements and positions.
 
‘The primary objective of the taskforce is to give clinicians of all types a single source of truth, one place they can go to where they know that they are the national guidelines, that they’re trustworthy, they’ve got the support of all the peak clinical groups and also that they’re up to date with the latest research.’
 
The guidelines are unique in that they are classed as ‘living’. Where traditional guidelines are developed every four to five years, these will be updated with new research in near real-time to give clinicians across primary, acute and critical care settings reliable, up-to-the minute recommendations throughout the health crisis.
 
Clinicians are encouraged to submit any questions or suggestions they have regarding clinical care.
 
‘One of the real advantages of what we call a living evidence model is that it’s dynamic. So we do have the opportunity to respond to the key questions and concerns of clinicians,’ Associate Professor Elliott said.
 
‘We want to hear what their key clinical questions are, their concerns, fears, worries.’
 
The taskforce, convened by the Australian Living Evidence Consortium based at Cochrane Australia at Monash University, will identify and summarise emerging national and international research and data using evidence surveillance and automation technologies. This evidence will then be fed to guideline panels.
The results will be delivered into the hands of clinicians through a mobile web app.
 
The Federal Government has backed the project with $1.5 million from the Medical Research Future Fund, together with contributions from the Victorian Government, the Ian Potter Foundation and the Walter Cottman Endowment Fund managed by Equity Trustees.

Associate Professor Mark Morgan, Chair of the RACGP Expert Committee – Quality Care (REC–QC), is involved in the taskforce, chairing a panel with a focus on mild COVID-19, which will be of particular interest to GPs. However, as the crisis continues to unfold, he believes all guidelines are going to be relevant.

‘I suspect general practice will also be involved in looking after people with moderate or even severe COVID-19, particularly those people that look after patients in community hospitals or sadly when we start providing palliative care,’ he told newsGP.
 
‘Especially if hospitals were to become overwhelmed, then the role of GPs will rapidly increase.’
 
The first set of recommendations, currently available, cover:

• definitions of disease severity
• monitoring and markers of clinical deterioration
• antivirals and other disease-modifying treatments
• respiratory support.

Clinicians also have access to flowcharts to assist with decision-making. The first two cover management of patients with moderate to severe, and severe to critical COVID-19.
 
‘This has just come together literally in the last three weeks, and the guidance that we have available now on our website is just the start,’ Associate Professor Elliott said.
 
‘We’ll be updating every week and as we do that we’ll be increasing the scope, covering more questions and topics.’

Meanwhile, Associate Professor Morgan believes access to the guidelines will go a long way in helping to curb the anxiety being felt by many on the frontline.
 
‘One of the drivers of anxiety is uncertainty about how you should manage the clinical aspects of care. So having a place where people can regularly check what they should be doing and what the evidence is saying is best practice will be really helpful,’ he said.
 
‘As we develop these guidelines further, we’ll be trying to provide practical and useful pieces of information; the sort of questions that are coming up at the moment around whether you should be advising people to be taking paracetamol or ibuprofen, or whether you should be treating people with corticosteroids or not.
 
‘Those are the sort of questions that are very relevant to GPs trying to do the best for their patients.’
 
Another step forward for GPs in the fight against coronavirus has seen the Federal Government permit the use of electronic prescriptions. RACGP President Dr Harry Nespolon hailed the announcement as a ‘breakthrough’ following continued calls from the college to relax legislation during the pandemic.
 
Under the new arrangements, patients can get a prescription from their GP sent directly to their pharmacy of choice via email or phone, and the medication can be delivered to their door.
 
‘This is a vital part of the puzzle to enable GPs to continue providing the same quality care to their patients via telehealth as they do face-to-face,’ Dr Nespolon said.
 
‘This breakthrough that the RACGP argued strongly for will enable GPs to better support their patients during this pandemic and help to minimise the spread of COVID-19 in our community as people can access medical care and any medication they may need without needing to leave their home.’
 
Meanwhile, health authorities have extended their support for frontline healthcare workers in Victoria by expanding the testing criteria to include paid or unpaid healthcare, residential or disability care workers.
 
In addition, healthcare workers in Victoria who test positive to coronavirus or have unexpected and unprotected contact with a suspected patient, will be able to self-isolate in a hotel away from their families and flatmates at no personal cost.
 
The RACGP has more information on coronavirus available on its website.
 
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clinical guidelines coronavirus COVID-19

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