New statewide referral criteria for Advice on the management of long COVID have been developed by a clinical review panel of GPs and hospital-based clinicians who have expertise working with long COVID patients. These criteria are in effect from 1 July 2023.
Statewide Specialist Clinic Referral Criteria – Long COVID: Communications pack 2023
Background
New statewide referral criteria for Advice on the management of long COVID have been developed by a clinical review panel of GPs and hospital-based clinicians who have expertise working with long COVID patients. These criteria are in effect from 1 July 2023.
GPs and other primary care providers should check their local HealthPathways or care pathways website when considering a referral for a long COVID patient.
While most patients diagnosed with long COVID can and will be managed in primary care, health services have a role in providing specialist care under the Health Independence Program (HIP). This includes single organ symptoms (such as cardiology and neurology), allied health, and multidisciplinary services (such as rehabilitation, cardiac rehabilitation, pulmonary rehabilitation or joint cardiopulmonary services).
As we have moved to a different phase of the pandemic the treatment of acute COVID infections and post-COVID symptoms are expected as part of the health sector’s general care offering; referrals relating to post-COVID symptoms should not be treated differently to referrals received for other conditions.
Where a patient requires referral to a specialist in addition to primary care, GPs and primary care providers should follow the statewide referral criteria for Advice on the management of long COVID. This will ensure that patients receive timely access to the most appropriate hospital-level service, as close to where they live as possible. The criteria assume a probable or confirmed diagnosis of long COVID; patients should not be referred for diagnosis.
Statewide referral criteria provide referring clinicians clear and consistent guidance about which patients will be seen in public specialist clinics across Victoria and what investigations are necessary to support accurate prioritisation of referrals.
There are other statewide referral criteria that include reference to post-COVID-19 symptoms:
- Abnormal liver function tests
- Atrial fibrillation
- Chest pain
- Chronic refractory diarrhoea
- Headache
- Inflammatory arthritis
- Motor weakness or paraesthesia
- Movement disorders and dystonia
- New persistent or chronic pain related to COVID-19 infection
- Palpitations
- Stroke or transient ischaemic attack
- Vertigo (neurology)
A full list of revised criteria can be accessed on the official Victorian Department of Health website. More information is also available on the Victorian and Tasmanaian PHN Alliance website.
Referrals that do not meet the criteria because they are either not suitable or are missing essential investigations or information, will be declined and returned to the referrer. Patients will not be provided with an appointment or placed on a waiting list unless a complete referral compliant with the statewide referral criteria is received.
Please also note the recent introduction of new protocols governing timeframes for hospital-GP communication about non-admitted patient referrals. Health services can request, and GPs can still send, a named referral to public hospital specialist services. But it’s no longer a reason for rejecting a referral. See our summary of the Managing referrals to non-admitted specialist services in Victorian public health services policy.
Key messages
What is the main information for GPs?
- New statewide referral criteria for Advice on the management of long COVID are now in effect.
- While most patients diagnosed with long COVID can be managed in primary care, these clear, consistent criteria ensure patients requiring specialist care receive timely access to the most appropriate hospital-level service, as close to where they live as possible.
- GPs and other primary care providers should check their local HealthPathways or care pathways website when considering a referral for a long COVID patient. The criteria are also available at src.health.vic.gov.au/advice-management-long-covid
Draft news item
New statewide referral criteria for long COVID patients requiring specialist care
New statewide criteria for long COVID are now in effect across Victoria, making it easier for patients and GPs to navigate referrals to specialist hospital services for the small number of patients who may need specialist support.
GPs are being urged to check their local HealthPathways or care pathways website when considering a referral for a long COVID patient. This will ensure that patients receive timely access to the most appropriate hospital-level service, as close to where they live as possible.
While most patients diagnosed with long COVID can and will be managed in general practice and primary care, some patients require referral to hospital-based specialist clinics. From the data available, current prevalence estimates of long COVID (defined as symptoms lasting more than 12 weeks) in Australia range from 5 per cent to 10 per cent of COVID-19 cases.
The criteria were developed by a team of GPs and hospital clinicians experienced in long COVID treatment. They are for single organ symptoms (such as cardiology and neurology), allied health, and multidisciplinary services (such as rehabilitation, cardiac rehabilitation, pulmonary rehabilitation or joint cardiopulmonary services). The criteria assume a probable or confirmed diagnosis of long COVID; patients should not be referred for diagnosis.
Richmond GP Dr Jeannie Knapp is a GP adviser at North Western Melbourne Primary Health Network. She says that general practice is well placed to manage long COVID but the clear, consistent criteria are welcome when she needs to refer to hospital-level support.
“GPs are experts in multi-system care, we are care coordinators, and we provide holistic support and education to our patients. We have access to most of the same diagnostic services as hospitals and can mobilise a multidisciplinary team.
“However, sometimes we need to refer a patient to hospital specialists. Since the long COVID clinics in public hospitals have now closed, these statewide referral criteria give GPs consistent guidance about who and how we can refer.”
Dr Louis Irving, a respiratory physician who leads services for long COVID patients at the Royal Melbourne Hospital, said that while they don’t expect a huge number of referrals for long COVID patients, some patients do require a specialist to work closely with them on their road to recovery.
“We are now in a phase of the COVID-19 pandemic where most people who contract the disease can self-manage their symptoms at home and recover fairly quickly. Those who do require care after 12 weeks can usually work with their GP and primary care team on a rehabilitation plan. While recovery can take some time, most patients gradually recover over time.
“However, some patients do need to be seen at a hospital clinic. Our specialists can assess symptoms such as ongoing fatigue, breathlessness, cognitive impairment, loss of smell and taste, and sleep issues and offer advice on a suitable management plan.
GPs can visit [insert HealthPathways link] or visit src.health.vic.gov.au to view the criteria.
Dr Knapp’s recent article on reclaiming long COVID as a primary care issue is available here.
Social media messages and graphics
Click on the images below to download (.png).
Message 1:
New statewide referral criteria for GPs managing long COVID patients are now in effect.
Check your local [HealthPathways or care pathways website] or visit https://src.health.vic.gov.au/advice-management-long-covid when considering a referral for a long COVID patient.
This will ensure patients who need specialist care get it quickly and close to home.
Message 2:
GPs: are you considering a specialist referral for a long COVID patient?
While most long COVID patients can be managed in primary care, some will need to see a hospital specialist. Follow the new statewide referral criteria to ensure your patient receives the care they need.
Check your local [HealthPathways or care pathways website] or visit https://src.health.vic.gov.au/advice-management-long-covid