Recommendations for the recognition, diagnosis, and management of long COVID: a Delphi study.
COVID-19
clinical guidelines
general practice
long COVID
long-hauler
post-COVID-19 condition
post-acute sequelae of COVID-19 (PASC)
Journal
The British journal of general practice : the journal of the Royal College of General Practitioners
ISSN: 1478-5242
Titre abrégé: Br J Gen Pract
Pays: England
ID NLM: 9005323
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
20
04
2021
accepted:
07
06
2021
pubmed:
6
10
2021
medline:
4
11
2021
entrez:
5
10
2021
Statut:
epublish
Résumé
In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed. To provide a rapid expert guide for GPs and long COVID clinical services. A Delphi study was conducted with a panel of primary and secondary care doctors. Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus. Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support. Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
Sections du résumé
BACKGROUND
In the absence of research into therapies and care pathways for long COVID, guidance based on 'emerging experience' is needed.
AIM
To provide a rapid expert guide for GPs and long COVID clinical services.
DESIGN AND SETTING
A Delphi study was conducted with a panel of primary and secondary care doctors.
METHOD
Recommendations were generated relating to the investigation and management of long COVID. These were distributed online to a panel of UK doctors (any specialty) with an interest in, lived experience of, and/or experience treating long COVID. Over two rounds of Delphi testing, panellists indicated their agreement with each recommendation (using a five-point Likert scale) and provided comments. Recommendations eliciting a response of 'strongly agree', 'agree', or 'neither agree nor disagree' from 90% or more of responders were taken as showing consensus.
RESULTS
Thirty-three clinicians representing 14 specialties reached consensus on 35 recommendations. Chiefly, GPs should consider long COVID in the presence of a wide range of presenting features (not limited to fatigue and breathlessness) and exclude differential diagnoses where appropriate. Detailed history and examination with baseline investigations should be conducted in primary care. Indications for further investigation and specific therapies (for myocarditis, postural tachycardia syndrome, mast cell disorder) include hypoxia/desaturation, chest pain, palpitations, and histamine-related symptoms. Rehabilitation should be individualised, with careful activity pacing (to avoid relapse) and multidisciplinary support.
CONCLUSION
Long COVID clinics should operate as part of an integrated care system, with GPs playing a key role in the multidisciplinary team. Holistic care pathways, investigation of specific complications, management of potential symptom clusters, and tailored rehabilitation are needed.
Identifiants
pubmed: 34607799
pii: BJGP.2021.0265
doi: 10.3399/BJGP.2021.0265
pmc: PMC8510689
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e815-e825Subventions
Organisme : British Heart Foundation
ID : FS/17/16/32560
Pays : United Kingdom
Investigateurs
Nisreen Alwan
(N)
Emily Attree
(E)
Jennifer Blair
(J)
Mary-Ann Bowen
(MA)
Nicola J Brobbel
(NJ)
Ciara Burgess
(C)
Michael Cannell
(M)
Christopher Dixon
(C)
Nell Freeman-Romilly
(N)
Sonali Gaur
(S)
Thea Haldane
(T)
Melissa Heightman
(M)
Theresa Howe
(T)
Parul Kalia
(P)
Ramzi Khamis
(R)
Muhammed Asad Khan
(MA)
Emma Ladds
(E)
Amali Lokugamage
(A)
Harsha Master
(H)
Rebecca Macfarlane
(R)
Anna Paes
(A)
Sonia Parmar
(S)
Elizabeth Potter
(E)
Manoj Sivan
(M)
Sarah May Taylor
(SM)
Margarita Thomson
(M)
Avril Washington
(A)
Katherine Wildon
(K)
Commentaires et corrections
Type : CommentIn
Informations de copyright
© The Authors.
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