Project CARE COVID-impact Assessment & Response project by a team led by Dr Olukayode Adeeko (Newton Medical Centre) & students of University of Liverpool (on GP placements) from December 2020 to February 2021.
This example describes how our GP practice supported patients who had received a positive test result for COVID-19 and were classed as being in vulnerable categories. Further support to these patients was provided through the setup and use of virtual clinics.
This project drew upon the NICE guidance for managing the long-term effects of COVID-19 (NG188) and recommendations within section 1.1 of the guidance for identifying people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome. Appropriate follow up support was provided to patients where this was identified as being needed following a virtual clinic appointment.
Aims and objectives
- To identify those patients who have tested positive for COVID-19 and who are deemed vulnerable by virtue of their age, health conditions or their ethnicity (see Group 1 below)
- To offer support and practical help to those with ongoing post-COVID symptoms in Group 1
- To render help to those that might have been indirectly impacted by COVID-19 pandemic (see Group 2 below).
Group 1 vulnerable COVID-19 positive patients:
- Long-term conditions (LTC) with COVID-19
- Over 65s with COVID-19
- Sickle Cell Disease (SCD) family
- Those positive but whose 1st language may not be English (BAME and other minority ethnic groups)
Group 2 indirectly impacted by COVID-19:
- Asylum seekers and refugees
- Homeless and NFAs (no fixed abode) (Those in the blind spot, not on QoF register, neither covered by KPIs, DES, LES nor other quality markers in General Practice)
Reasons for implementing your project
The COVID-19 pandemic has had huge impacts on people around the globe. Elderly people and those with pre-existing chronic conditions including cardiovascular disease, cancer, hypertension, respiratory conditions and diabetes appear to be at a higher risk of developing complications and are at high risk of death.
NICE published new guidance on 18 December 2020: COVID-19 rapid guideline: managing the long-term effects of COVID-19 (NG188). This guideline covers identifying, assessing and managing the long-term effects of COVID-19, often described as ‘long COVID’.
It makes recommendations about care in all healthcare settings for adults, children and young people who have new or ongoing symptoms 4 weeks or more after the start of acute COVID-19. It also includes advice on organising services for long COVID-19.
Patients with Sickle Cell Disease (SCD) often have underlying cardiopulmonary co-morbidities that may predispose them to poor outcomes if they become infected with SARS-CoV-2. It was recommended that SCD patients infected with COVID-19 should be followed very closely, applying a low threshold for admission and frequent outpatient check-ins via telemedicine or in person as appropriate, particularly following hospital discharge.
The homelessness response to COVID-19 has seen extraordinary action taken across Great Britain to get everyone into safe accommodation during the pandemic. People experiencing homelessness have been struggling to meet their basic needs during the COVID-19 pandemic.
Many factors influence how people have been impacted by the pandemic including access to appropriate accommodation, adequate healthcare, sufficient food supplies and welfare benefits. All these factors can be directly affected and compounded by a person’s immigration status.
The impact of COVID-19 on people who are in the asylum system, refugees or those who have no recourse to public funds (NRPF) can be enormous. NRPF is a condition imposed on an individual based on their immigration status which means they cannot access welfare benefits, public housing and some healthcare. This might include people who have limited leave to remain, refused asylum-seekers who are ‘appeal rights exhausted’, those with no status or no documents to prove their status or European Economic Area (EEA) citizens unable to pass the right to reside test.
How did you implement the project
A search of positive COVID-19 cases amongst the over 65s, those with LTCs, on DMARDs and BAME who tested COVID-19 first in early in December 2020, then in January 2021 and finally in early February 2021 was carried out. A search of patients who had a current status as of asylum seekers, refugee, homeless and NFA (no fixed abode) was conducted. A weekly mid-week dedicated virtual clinic was set up from December 2020 to early February 2021 to provide support for the cohorts of patients. NICE guidance recommendations 1.4 and 1.7 set out the framework for initial consultation and shared decision making with the patient to agree on any follow up support identified as being helpful to support their recovery. This was a new, innovative and dedicated clinic set up specifically to help address the needs of those impacted by COVID-19 infection at the height of the second wave of the pandemic.
The clinic was run every Wednesday afternoon at lunchtime by the lead GP, supported by the medical students under their supervision (this was outside the normal core GP sessions and was in addition to the regular GP access available to the rest of the patients). All the identified patients received welfare calls via telephone, during which their needs assessments were carried out and the most appropriate support and/or help provided. A few calls resulted in face-to-face consultations.
Total number of patients who tested COVID-19 (as at 2/2/21) = 271
Number of over 65s, those with LTCs, on DMARDs and BAME who tested COVID-19 (as at 2/2/21) = 112 i.e. 41%
Therefore, representing more than 4 in 10 of the COVID-19 positive cases in the practice.
Regarding post-COVID symptoms, out of the 112:
- 54 people reported NO post-COVID symptoms
- 51 patients reported one or more lingering symptoms (see table 1 for details)
- 7 patients were unreachable after several attempts
Regarding ongoing concerns, of the 51 with post-COVID symptoms:
- 12 people answered YES (i.e. 23.5%)
- 39 patients said NO (76.5%)
- So, more than 3 out of 4 cases improved or resolved spontaneously or with some support.
- Some or most of the 39 above were offered support regarding the management of their LTC during COVID-19 pandemic, some needed signposting to relevant services in the community, emotional support and reassurance provided, and practical help in a few cases.
- 9 patients were referred to the newly established home oximetry monitoring service in the area
- 1 case continued to receive home case via the community matron
- 2 patients were referred for counselling
Overall achievement of the project
All the over 65s, those with LTCs, on DMARDs and BAME who tested COVID-19 as at 2/2/21 (with the exemption of 7 patients were unreachable after several attempts) were assessed virtually after their COVID-19 diagnosis for their needs, offered support where indicated and practical help as required. Those in the ‘blind spot’ and the family with SCD were offered support and received help as required.
Key learning points
A significant proportion of the elderly people and those with pre-existing chronic conditions who tested positive for COVID-19 infection do require additional support. So, it is important to contact them and do a needs assessment and offer any necessary support.
Proactive care, early interventions and support helped in improving post-COVID symptoms in many instances. The needs of those in the ‘blind spot’ groups could inadvertently be overlooked during this pandemic, so their needs assessment should be conducted and support should be provided where indicated.
Patients do appreciate this extra support as noted in the feedback from the virtual clinics.