GP consultation rates for sequelae after acute covid-19 in patients managed in the community or hospital in the UK: population based study

Abstract

Objectives: To describe the rates for consulting a general practitioner (GP) for sequelae after acute covid-19 in patients admitted to hospital with covid-19 and those managed in the community, and to determine how the rates change over time for patients in the community and after vaccination for covid-19.

Design: Population based study.

Setting: 1392 general practices in England contributing to the Clinical Practice Research Datalink Aurum database.

Participants: 456 002 patients with a diagnosis of covid-19 between 1 August 2020 and 14 February 2021 (44.7% men; median age 61 years), admitted to hospital within two weeks of diagnosis or managed in the community, and followed-up for a maximum of 9.2 months. A negative control group included individuals without covid-19 (n=38 511) and patients with influenza before the pandemic (n=21 803).

Main outcome measures: Comparison of rates for consulting a GP for new symptoms, diseases, prescriptions, and healthcare use in individuals admitted to hospital and those managed in the community, separately, before and after covid-19 infection, using Cox regression and negative binomial regression for healthcare use. The analysis was repeated for the negative control and influenza cohorts. In individuals in the community, outcomes were also described over time after a diagnosis of covid-19, and compared before and after vaccination for individuals who were symptomatic after covid-19 infection, using negative binomial regression.

Results: Relative to the negative control and influenza cohorts, patients in the community (n=437 943) had significantly higher GP consultation rates for multiple sequelae, and the most common were loss of smell or taste, or both (adjusted hazard ratio 5.28, 95% confidence interval 3.89 to 7.17, P<0.001); venous thromboembolism (3.35, 2.87 to 3.91, P<0.001); lung fibrosis (2.41, 1.37 to 4.25, P=0.002), and muscle pain (1.89, 1.63 to 2.20, P<0.001); and also for healthcare use after a diagnosis of covid-19 compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients in the community were joint pain (2.5%), anxiety (1.2%), and prescriptions for non-steroidal anti-inflammatory drugs (1.2%). Patients admitted to hospital (n=18 059) also had significantly higher GP consultation rates for multiple sequelae, most commonly for venous thromboembolism (16.21, 11.28 to 23.31, P<0.001), nausea (4.64, 2.24 to 9.21, P<0.001), prescriptions for paracetamol (3.68, 2.86 to 4.74, P<0.001), renal failure (3.42, 2.67 to 4.38, P<0.001), and healthcare use after a covid-19 diagnosis compared with 12 months before infection. For absolute proportions, the most common outcomes ≥4 weeks after a covid-19 diagnosis in patients admitted to hospital were venous thromboembolism (3.5%), joint pain (2.7%), and breathlessness (2.8%). In patients in the community, anxiety and depression, abdominal pain, diarrhoea, general pain, nausea, chest tightness, and tinnitus persisted throughout follow-up. GP consultation rates were reduced for all symptoms, prescriptions, and healthcare use, except for neuropathic pain, cognitive impairment, strong opiates, and paracetamol use in patients in the community after the first vaccination dose for covid-19 relative to before vaccination. GP consultation rates were also reduced for ischaemic heart disease, asthma, and gastro-oesophageal disease.

Conclusions: GP consultation rates for sequelae after acute covid-19 infection differed between patients with covid-19 who were admitted to hospital and those managed in the community. For individuals in the community, rates of some sequelae decreased over time but those for others, such as anxiety and depression, persisted. Rates of some outcomes decreased after vaccination in this group.

Fig 1

Study design. Follow-up period for the pre-covid-19 population (patients before having a covid-19 diagnosis) was defined in the same way as for the post-covid-19 population (patients after having a covid-19 diagnosis). The post-covid-19 vaccination population was defined as all patients who tested positive for covid-19, as defined for the post-covid population, and received a first vaccine dose for covid-19 at a later date. Start of follow-up for the vaccination population was the date of vaccination and end of follow-up was the same as for the post-covid population. CPRD=Clinical Practice Research Datalink Aurum. *In patients with at least one symptom outcome post-covid-19

Fig 2

General practitioner consultation rates for clinical outcomes after covid-19 infection compared with 12 months before covid-19 infection, in patients admitted to hospital with covid-19, in patients managed in the community, and in the influenza cohort. Forest plots show hazard ratios (95% confidence interval) for each outcome developed versus each outcome not developed, separately, during follow-up. Analyses were adjusted for age, sex, body mass index, Charlson comorbidity index, and smoking status. NSAIDs=non-steroidal anti-inflammatory drugs

Fig 3

Incidence of healthcare use outcomes after covid-19 infection compared with 12 months before covid-19 infection, in patients admitted to hospital with covid-19, in patients managed in the community, and in the influenza cohort. Forest plots show incidence rate ratios (95% confidence interval) for each outcome developed during follow-up. Analyses were adjusted for age, sex, body mass index, Charlson comorbidity index, and smoking status

Fig 4

Crude general practitioner consultation rates for symptoms, diseases, and drug prescriptions for each month after a covid-19 diagnosis in patients managed in the community. Only diseases and symptoms that had a significant increase in rate of occurrence after covid-19 were included. All drug prescription outcomes were included, regardless of whether they were significantly associated with an increase after covid-19. NSAIDs=non-steroidal anti-inflammatory drugs

Fig 5

General practitioner consultation rates for symptoms, diseases, drug prescriptions, and healthcare use after a covid-19 diagnosis in patients managed in the community who received a vaccine dose for covid-19 after diagnosis. Forest plots show incidence rate ratios (95% confidence interval) adjusted for age, sex, Charlson comorbidity index, body mass index, smoking, and time since covid-19 diagnosis for all outcomes, excluding venous thromboembolism, paraesthesia, and palpitations where adjustment for body mass index was not possible because of low number of events. Irritable bowel disease is not shown because of 0 events recorded during follow-up. NSAIDs=non-steroidal anti-inflammatory drugs