Post-COVID-19-syndrome: a quality improvement case study utilising a call-recall approach

Conference: 
2021 SAPC North (virtual)
Talk Code: 
2A.6
Presenter: 
JJ Hutchinson
Co-authors: 
Hutchinson, J.J.1 Kaushik, N.2 Murphy, G.2
Author institutions: 
1. Academic Clinic Fellow, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK 2. GP, Bowland Medical Practice, Wythenshawe, Manchester

Background

2.3% of COVID-19 patients have symptoms beyond 12 weeks, post-covid-19-syndrome.  This is an important problem for general practice, whom patients will seek advice from.

Call-Recall systems, where eligibility criteria are used to trigger health service contact, are routinely used for processes such as cervical screening. We chose to adapt and evaluate this for post-covid-19-syndrome.

The Approach

Aim: Assess 100% of patients infected with SARS-CoV-2 to identify and offer clinical assessment for patients with ongoing symptoms.

The QIP had two PDSA cycles. Initial design was consulting all patients with a positive SARS-CoV-2 swab starting in September 2021. Due to the high incidence of COVID-19 in Autumn/Winter 2021 this failed. Subsequently, patients with a positive SARS-CoV-2 swab were texted 6 weeks from their positive swab, replying with whether they had symptoms. Patients with symptoms were then invited for clinic review

Timescales were chosen to align with our funding source, Manchester Primary Care Standards.

Evaluation was via descriptive statistics and a reflective assessment of the pathway.

Findings

7% of the practice population had COVID-19 infection. 47% of these were contacted with 11% of these diagnosed with post-covid-19-syndrome.

The greatest learning comes from the reflection:

  1. Patients infected when widespread testing was not available are difficult to identify.
  2. Incidence of COVID-19 makes streamlining pathways necessary.
  3. Vulnerable patients may not be able to use the call-recall process
  4. Some patients do not respond to the SMS, these may have less significant symptoms.
  5. This required 2 sessions a week to run, possible due to local funding. Generalisability without this funding may be difficult.

Implications

Hopefully post-covid-19-syndrome will become rare as the vaccination reduces incidence. If necessary, a Call-Recall approach is easy to implement with appropriate funding. However, no evidence exists regarding its cost-effectiveness or clinical benefit.