ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.
ABSTRACT
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.