Predictors and Outcomes for COVID-19 Re-Admissions in the Anticipate Cohort.

Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.

USE OF TELEMEDICINE IN GENERAL PRACTICE IN EUROPE SINCE THE COVID-19 PANDEMIC: A SCOPING REVIEW OF PATIENT AND PRACTITIONER PERSPECTIVES

General practice is generally the first point of contact for patients presenting with COVID-19. Since the start of the COVID-19 pandemic general practitioners across Europe have had to adopt to using telemedicine consultations in order to minimise the number of social contacts made.(1). The aim of this study was to conduct a scoping review of the literature examining the use of telemedicine for delivering routine GP care since the start of the pandemic from the perspectives of patients and practitioners. We used the six-stage scoping review framework developed by Arksey and O'Malley (2). The search process was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A total of 19 studies across nine countries were included in the review. Thirteen studies explored the practitioner perspective of the use of telemedicine in general practice since the COVID-19 pandemic, while six studies looked at the patient perspective. The types of studies included in this review were: qualitative studies, literature reviews, a systematic review, observational studies, quantitative studies, Critical incident technique study, and surveys employing both closed and open styled questions. Key themes identified related to the patient/ practitioner experience and knowledge of using telemedicine, patient/ practitioner levels of satisfaction, GP collaboration, nature of workload, and suitability of consultations for telemedicine. Our findings suggest a level of acceptability and satisfaction of telemedicine by GPs and patients during the pandemic;however, further research is warranted in this area.

ENHANCING GP CARE OFMENTAL HEALTH DISORDERS POST COVID-19: A SCOPING REVIEW OF INTERVENTIONS, OUTCOMES

Considerable literature has reported the COVID-19 pandemic's negative mental health sequelae. This surge in mental health problems will likely present to primary care in the coming months. The development of interventions to support GPs in the care of patients with mental health problems is a priority. The aim of this review was to examine interventions which could be implemented in general practice to enhance care of mental health disorders post COVID-19. PubMed, PsycINFO, Cochrane Library, Google Scholar and WHO Global Research on COVID-19 databases were searched following Arksey and O'Malley's scoping review process(1). Initial searches identified 148 articles. Twenty-nine studies were included in the review, mostly randomised control trials, qualitative interviews and surveys. Outcome measures to test feasibility of interventions included the 'Seven-item Generalised Anxiety Disorder Scale' and 'Nine-item Patient Health Questionnaire'. Results were divided into themes: Interventions to improve identification of mental health disorders;Interventions to support GPs;Therapeutic interventions;Telemedicine interventions, and barriers and facilitators to intervention implementation. Interventions requiring active involvement of patients in their own care may be effective. GPs should encourage participation in physical activity andmeditation, implement digitalmental health interventions and incorporate telemedicine into their practice. Our findings suggest a broad range of interventions may be implemented in primary care to tackle the mental health sequelae of COVID-19. Practitioners worldwide must stay informed of relevant research, and actively implement studied interventions to improve the mental health care they offer. Priority areas for future research include biological treatments for mental health sequelae of COVID-19.

ENHANCING THE MANAGEMENT OF LONG COVID IN GENERAL PRACTICE: A SCOPING REVIEW

Persistent symptomatic COVID-19 is a multi-system condition that affects approximately 10% of those with acute COVID-19 infection. Affected patients often have complex care needs requiring holistic and multidisciplinary care approaches, the kind routinely provided in general practice. However, there is a lack of evidence of appropriate general practice interventions for the condition. A scoping review was conducted using Arksey and O'Malley's 2005 five-stage framework[1], with later recommendations by Levac et al.[2] to examine the literature and identify knowledge gaps in general practice management of persistent COVID-19. Nineteen papers were selected for review. The studies spanned numerous geographical locations, encompassing several study designs, and a range of populations and sample sizes. The included studies used various definitions for persistent symptomatic COVID-19. The literature was analysed qualitatively, and six major themes were identified. These themes were (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 integratedmulti-disciplinary care and (vi) Need to facilitate psychological support. Overall, the findings show that general practitioners play a key role in the management of persistent COVID-19, but that more clinical guidance on appropriate interventions is necessary to enhance care. There is a need for scientifically accepted definitions for persistent COVID-19 to ensure that patients can be recognized, assessed and managed appropriately. Patient and public involvement should guide policy makers when developing future care models. Meanwhile, future research should evaluate the implementation and effectiveness of proposed management strategies and interventions.

Cross-sectional study of palliative care to hospitalised patients with COVID-19

Aims: To describe the characteristics, symptoms and outcomes for patients with COVID-19 referred to a hospital-based specialist palliative care service and to describe communication and visiting practices. Methods: A descriptive cross-sectional retrospective study, which is a part of the ANTICIPATE study project. Results: 50 patients were referred;49 included in analysis. 38 patients died. 27 patients were male;median age was 81 years. On referral, median Charlson Comorbidity Index was 6;median Australia-modified Karnofsky Performance Status score was 20%. Median number of days from referral to death was 2. Common baseline symptoms (n) were dyspnoea (35), agitation (23), and pain (13). Opioids (100%), benzodiazepines (97.1%) and neuroleptics (61.8%) were most commonly used medications to achieve symptom control. 13/19 patients with serial data had a decrease in Palliative Care Problem Severity Score. 26 patients received a family visit before death;8 had virtual forms of contact. 9 patients had family present at time of death. Conclusion: The short interval from referral to Specialist Palliative Care and death indicates the need for prompt service response. Data on visiting highlights challenges of providing psychosocial support.

Responding to COVID-19 related mental health impacts among elite athletes

The COVID-19 pandemic has impacted considerably on elite athletes' performance. In this paper, we aim to examine how the psychosocial effects of COVID-19 may impact on athletes. First, mental health problems are as common among elite athletes as among the general population. Second, the mental health effects of COVID-19 are common in adolescents and young adults. Third, there are recognised gender differences in mental health related help-seeking behaviour. There is emerging evidence that these issues may be exacerbated by the pandemic. While there is little evidence on what interventions may help to address this problem, it is possible that optimising the identification and treatment of mental health problems (in an appropriate and acceptable manner) and promoting team cohesion and interaction may be effective. Addressing this issue is important for all team doctors and healthcare professionals associated with sports teams (both elite and non-elite).

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

Background: About 10-35% of people with COVID-19 merit medical care within 3 weeks of infection. However, the prevalence of ongoing care needs among individuals experiencing severe COVID-19 illness is unclear. Research question: What is the prevalence of ongoing care needs among severe COVID-19 patients? Methods: This pilot study applied a cross-sectional design whereby data was collected from adult patients attending a post-COVID-19 follow-up clinic at the Mater Misericordiae University Hospital, Dublin, Ireland, 3-6 months after their initial presentation at the clinic. Participants completed questionnaires documenting their demographics, medical histories, hospital admissions/re-admissions where applicable, and where relevant, primary care service use following hospital discharge. Analyses were conducted using descriptive/inferential statistics. Results: Participants' (n=153) median age =43.5 (IQR =30.9-52.1). There were 105 females (68.6%) and 48 males (31.4%). Various medical histories were reported among participants. 67 (43.2%) reported being admitted to the hospital for COVID-19. Older individuals, males, ICU admissions, and re-admissions were common among hospital attendees. Of the hospital attendees, 16 (24%, 95% CI =13.7-34.2%) and 26 (39%, 95% CI =27.3-50.7%) attended general practices within seven and 30 days of hospital discharge. Older adults (median age =49.8 years), people with pre-existing medical conditions, and individuals admitted to ICU/readmitted to hospital were common among general practice attendees. Conclusion: Persistent health issues appear to be common among patients who experienced severe COVID-19 illness. Older adults, people with pre-existing health problems, and individuals who received ICU and/or re-admission care may have greater long-term care needs requiring attention.

Caring for opioid drug users during the covid-19 pandemic – a commentary on the irish experience

The management of COVID-19 disease is threatening health systems globally. People who use drugs, in particular opioid users, have increased vulnerability. Targeted adaptations of opioid agonist treatment (OAT) are required to protect this vulnerable population and the healthcare workers providing services. In this article we describe and discuss the associated evidence for the measures implemented to reduce the risks associated with COVID-19 to Irish OAT services. Irish OAT services have implemented the following measures: reduced supervision requirements, increased the use of virtual patient care, streamlined assessment and induction processes to remove barriers to OAT access, provided home delivery of medi-cations, increased access to naloxone and overdose programmes, targeted health and social interventions for the homeless and reduced our prison population. For now, non-essential services including drug and blood-borne virus screening and hepatitis C treatment have been postponed. Planning and review of Irish OAT services is ongoing so that further adaptations can be implemented as challenges emerge. Rapid adaptation of OAT services is required to reduce the impact of COVID-19 on patients, staff and the general public. Ongoing evaluation of these measures is critical since many of these changes may have an enormous impact on health and social care outcomes and be cost saving in a post-COVID future. Furthermore, these positive changes may address some of the social and health inequalities experienced by so many.

Changing practices of decision making regarding do-not-attempt-cardiopulmonary-resuscitation orders amid the COVID-19 pandemic

Introduction: The COVID-19 pandemic has brought the decision-making process regarding cardiopulmonary resuscitation into focus. This study aims to analyse Do-Not-Attempt CPR (DNACPR) documentation in older hospitalised patients before and during the COVID-19 pandemic. Methods: This was a retrospective repeated cross-sectional study. Data including comorbidities and resuscitation status was collected on 300 patients with COVID-19 hospitalised from March 1st toMay 31 s t 2020. DNACPR documentation rates in patients aged ≥65 years with a diagnosis of COVID-19 were compared to those without COVID- 19 admitted during the same period. Pre-COVID-19 pandemic DNACPR documentation rates were also examined. Factors associated with DNACPR order instatement during the first wave of the COVID-19 pandemic were identified. Results: Of 300 COVID-19-positive patients, 28% had a DNACPR order documented during their admission. 50% of DNAR orders were recorded within 24 hours of a positive swab result for SARS-CoV-2. Of 131 patients aged 65 years or over within the cohort admitted with COVID-19, 60.3% had a DNACPR order compared to 25.4% of 130 patients ≥65 without COVID-19 (p<0.0001). During a comparable time period prepandemic, 15.4% of 130 older patients had a DNACPR order in place (p<0.0001). Independent associations with DNACPR order documentation included increasing age (Odds Ratio [O.R.] 1.12;95% CI 1.05-1.21);nursing home resident status (O.R. 3.57;95% CI 1.02-12.50);frailty (O.R. 3.34;95% CI 1.16-9.61) and chronic renal impairment (O.R. 5.49;1.34-22.47). The case-fatality-rate of older patients with COVID-19 was 29.8% versus 5.4% without COVID-19. Of older COVID-19-positive patients, 39.2% were referred to palliative care services and 70.2% survived. Conclusion: The COVID-19 pandemic has prompted more widespread and earlier decision-making regarding resuscitation status. Although case-fatality-rates were higher for older hospitalised patients with COVID-19, many older patients survived the illness. Advance care planning should be prioritised in all patients and should remain clinical practice despite the pandemic.

Child and adolescent mental health service: extension for community health care options [CAMHS ECHO]

Aims To explore the feasibility and identify the perceived barriers and enablers of developing an ECHO programme for CAMHs in Ireland. Methods The study adopted a qualitative research design incorporating a CAMHS:ECHO seminar and workshops with (N=29) healthcare professionals working in primary care/ mental health services. Participant consent was received, and thematic analysis conducted on rapporteur notes. Results Clinicians reported a high-level of interest in the project. Perceived opportunities included potential reduction in CAMHS waiting lists, opportunity for shared care of ADHD, improved time management, clinical skills, and access to advice on referrals. Perceived challenges included the issue of clinical governance, increased GP workload and the issue of incentives. Conclusion Barriers to successful rollout of an ECHO model in CAMHS were outweighed by perceived benefits and enablers identified by participants. Given the increased use and acceptability of telepsychiatry during COVID-19, coupled with the positive support offered by attendees, consideration should be given to more formally piloting CAMHS:ECHO.

Anticipate study protocol: Baseline profile and care outcomes of patients attending Mater Misericordiae University Hospital with COVID-19 infection

<b>Background:</b> While the COVID-19 pandemic is currently impacting on health and social care in Ireland, this impact is most marked in metropolitan Dublin. This is especially the case for the Mater Misericordiae University Hospital (MMUH) in Dublin's North Inner, which is situated in an area where local socially deprived communities are at high risk of infection and of experiencing adverse outcomes. <b>Aims:</b> To determine baseline characteristics and longer-term care outcomes of COVID-19 patients presenting to / attending the Infectious Diseases Department at MMUH, including the virtual clinic.