Authors' objectives: Long COVID can impact the patients' everyday functioning, including long absenteeism at school or work. As a result, the disease not only places a burden on patients and their families but also on the economy, especially the labour market. The present scoping review updated the recommendations on care pathways for adult long COVID patients and added recommendations for children and adolescents. In addition, it presents further existing long COVID care structures in selected European countries.

Authors' results and conclusions: According to the recommendations, the majority of long COVID healthcare should be provided in primary care, e.g. by general practitioners, primary care centres or paediatricians. In some countries (e.g., UK, Netherlands, Italy, Spain, and USA), formerly hospitalised COVID-19 patients who have persistent or new symptoms 12 weeks after discharge may also attend hospital outpatient departments for clinical evaluation. Regarding the care for children and adolescents, parents and caregivers present one of the most important pillars and should always be involved in making decisions. Patients with multiple symptoms persisting for more than 12 weeks may be referred to specialised long COVID outpatient clinics for further evaluation. For children and adolescents, so-called "one-day assessments" are recommended. This means that all examinations and tests are performed in one day, thus avoiding multiple referrals. Patients with a dominant symptom that persists between four and 12 weeks after the acute infection should be referred to the appropriate specialist. Depending on the patient's needs, further care options include referral to rehabilitation and/or non-medical healthcare providers. Besides primary care, self-management presents another important pillar of long COVID care. This includes, e.g., exercising at home, nutritional management or stress reduction, but also participation in long COVID programmes online or via specific Apps. According to the recommendations, self-management can function as a single therapy for milder long COVID symptoms or complementary in addition to other treatments for moderate to severe symptoms. Regarding additional (social) support, the same support as for other (chronic) illnesses, including, for example, work-related benefits, such as sick leave or retraining programmes, and school-specific arrangements, such as a gradual return, were also suggested for long COVID patients.

Authors' recommendations: Overall, long COVID care comes with the interplay of various systems next to the healthcare system, including the social care system, employment or education system and the family. This interplay is essential when it comes to the care of children and adolescents. Therefore, planning long COVID care structures requires coordinating support across these different (and usually fragmented) systems and guaranteeing a care that addresses the individual needs of patients and their families.

Authors' methods: Besides the systematic search and additional hand searches conducted for the original report published in October 2021, update hand searches were performed until the beginning of July 2022 to identify further guidelines. In addition, numerous internet searches for relevant information about institutions and care facilities in the selected European countries were conducted until early August 2022. Interdisciplinary experts were contacted for further unpublished information.

Project Status: Completed

URL for project: https://aihta.at/page/update-of-long-covid-care-pathways-and-structures/en

Year Published: 2022

URL for published report: https://eprints.aihta.at/1408/1/HTA-Projektbericht_Nr.135b_Update.pdf

URL for additional information: https://eprints.aihta.at/1408/

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Austria

Organisation Name: Austrian Institute for Health Technology Assessment

Contact Address: Garnisongasse 7/20, A-1090 Vienna, Austria

Contact Name: office@aihta.at

Contact Email: office@aihta.at

Copyright: HTA Austria - AIHTA GmbH