Support and education for GPs feature prominently in the parliamentary inquiry’s recommendations.
GPs will provide most of the care needed by people with long covid and should be supported accordingly, including by a review of the MBS chronic disease management item number, recommends the parliamentary inquiry into long covid and repeated covid infections.
The inquiry’s report, released today, concludes with nine recommendations, including one which seems to backflip on the government’s decision to end its funding of the National Clinical Evidence Taskforce’s living guidelines at the end of last year.
On a big day for patients with long covid, Health Minister Mark Butler announced the government will provide a further $50 million from the Medical Research Future Fund for research into the condition, “as an initial response to the inquiry”.
GPs, says recommendation six, should get support and education to diagnose long covid and to help manage those suffering from it.
“Education for GPs should be coordinated and eligible for CPD. The MBS chronic disease management item number should be reviewed,” said the report.
“Mental health support for those with long covid must be provided in an affordable, timely and equitable manner, and regular review of mental health issues should be part of GP management noting that the extent of related mental health impacts is still unknown.
“Telehealth and digital health resources should be leveraged to make self-management and access to primary care easier.
“Funding should be provided so that outreach long covid clinics can be developed for rural and regional areas, accessible either face-to-face or via telehealth, as a GP resource.”
RACGP president Dr Nicole Higgins said the college welcomed the report’s recommendations.
“GPs across Australia are caring for people with long covid – this is a debilitating illness, and much more needs to be done to understand it and support those experiencing it,” she said.
“I’m pleased the report recognises the essential role of GPs in diagnosing and caring for people with long covid. GPs are expert in managing chronic disease and are best placed to provide ongoing care for those experiencing long covid and coordinating the patient’s care with other specialists and health professionals.
“The report also recognises the challenges GPs face because this is a new disease and we don’t even have an agreed definition of long covid for use in Australia, let alone clinical guidelines to help GPs diagnose and care for people with long covid. The development of these key clinical tools will make a big difference for people with long covid.
“Many of the committee’s recommendations reflect what the RACGP called for in our submission, including greater investment in data collection and research into long covid. Research funding should be directed to general practice, where the bulk of patient care is taking place.
“The RACGP also wants to see ongoing support for the National Clinical Evidence Taskforce. The taskforce plays an essential role in collating and analysing emerging international evidence into covid and long covid, and we need this to maintain a living guideline for GPs and other specialists and health professionals in Australia to ensure patients get the best evidence-based care.”
Dr Higgins also called for immediate support for long covid patients.
“It’s disappointing the report doesn’t recommend immediate measures for people suffering distress and disability from long covid,” she said.
“Patients’ Medicare rebates don’t adequately support people with long covid. It’s a complex chronic condition and it requires more of a GP’s time, but the current patient rebates penalise GPs for spending longer with patients.
“Covid and long covid are here to stay. Vaccination is our best protection against this virus, and it reduces the risk of long covid. But for those who do contract long covid, access to evidence-based medical care and support is essential to ensure they have the best chance of recovering and living a full life.”
The lack of a standard definition of long covid was addressed by the committee which recommended that the WHO’s definition – “the continuation or development of new symptoms three months after the initial SARS-CoV-2 infection, with these symptoms lasting for at least two months with no other explanation” – be used clinically, pending a review “as more research and information becomes available”.
On 15 December 2022, the Taskforce announced that the Department of Health and Aged Care had cancelled its contract to develop and maintain living guidelines.
In what can only be seen as an acknowledgement of the prematurity of that decision, the committee report called for the development of “evidence-based living guidelines for diagnosis and treatment incorporating tiered care including referral pathways, co-designed with patients with lived experience”.
Data and research
The report also banks on the establishment of a Centre for Disease Control, recommending that it house and administer a “single covid-19 database” capturing data on covid-19 infections, complications, hospitalisations and deaths, as well as recurrent covid infections.
The database would also include data on long covid diagnoses, including post-covid complications, covid vaccination rates, vaccination side-effects and post vaccination deaths.
As for collecting the data across jurisdictions, the report recommended the government explore the use of AI, self-managed care platforms, and data linkage within and between states and territories.
Recommendation three focused on the establishment of a “nationally coordinated research program, led by a CDC”.
“This funding should be longer term and be nationally coordinated. The funding should aim to better integrate research by fostering greater collaboration rather than fragmentation,” the report said.
“The Committee also recommends that this research have adequate representation from Aboriginal and Torres Strait Islander peoples and the culturally and linguistically diverse population and be adequately funded to achieve these aims. Other vulnerable groups including the elderly, children, people with disability and the immunosuppressed should be represented.
“Research programs should span basic science, clinical trials, models of care, health promotion and implementation science.”
The inquiry committee wants the PBAC to review the use of antivirals with a view to “expanding the list of groups eligible to access these treatments through the PBS”.
“The Committee also recommends that antiviral treatments for covid be approached as a pharmacist-initiated medication to participants eligible under the PBS,” the report also said.
“The Committee additionally recommends that the Australian Government review its framework for access to antiviral treatments for covid to include non-mortality and non-hospitalisation outcomes such as productivity gains, time to illness resolution, return to work and number of health encounters.”
Air quality advocates have had a win, buried in recommendation seven of the report, in which the committee calls for the establishment of a “multidisciplinary advisory body” to oversee an assessment of the impact of poor air quality and ventilation on the economy, “with particular consideration given to high-risk settings such as hospitals, aged care facilities, childcare and educational settings”.
That group should also lead the development of national indoor air quality standards, the report said.