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Home-care guidelines for patients with COVID-19

guidelines for patients with COVID-19 Home-care guidelines for patients with COVID-19 DisclaimerThe information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional the text is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis a

100 Wellington Parade East Melbourne, Victoria 3002 Tel 03 8699 0414 Fax 03 8699 0400 www.racgp.org.au ABN: 34 000 223 807 ... support general practice teams to collaborate with local hospital services in the care of patients with COVID-19. The RACGP acknowledges the work of the National COVID-19 Clinical Evidence Taskforce (of which the RACGP ...

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Transcription of Home-care guidelines for patients with COVID-19

1 guidelines for patients with COVID-19 Home-care guidelines for patients with COVID-19 DisclaimerThe information set out in this publication is current at the date of first publication and is intended for use as a guide of a general nature only and may or may not be relevant to particular patients or circumstances. Nor is this publication exhaustive of the subject matter. Persons implementing any recommendations contained in this publication must exercise their own independent skill or judgement or seek appropriate professional advice relevant to their own particular circumstances when so doing. Compliance with any recommendations cannot of itself guarantee discharge of the duty of care owed to patients and others coming into contact with the health professional and the premises from which the health professional the text is directed to health professionals possessing appropriate qualifications and skills in ascertaining and discharging their professional (including legal) duties, it is not to be regarded as clinical advice and, in particular, is no substitute for a full examination and consideration of medical history in reaching a diagnosis and treatment based on accepted clinical , The Royal Australian College of General Practitioners Ltd (RACGP)

2 And its employees and agents shall have no liability (including without limitation liability by reason of negligence) to any users of the information contained in this publication for any loss or damage (consequential or otherwise), cost or expense incurred or arising by reason of any person using or relying on the information contained in this publication and whether caused by reason of any error, negligent act, omission or misrepresentation in the citationThe Royal Australian College of General Practitioners. Home-care guidelines for adult patients with mild COVID-19 . East Melbourne, Vic: RACGP, Royal Australian College of General Practitioners Ltd 100 wellington Parade East Melbourne, Victoria 3002 Tel 03 8699 0414 Fax 03 8699 0400 : 34 000 223 807 ISBN: 978-0-86906-604-1 Published August 2020, updated December 2021 The Royal Australian College of General Practitioners 2021 This resource is provided under licence by the RACGP.

3 Full terms are available at au/usage/licence. In summary, you must not edit or adapt it or use it for any commercial purposes. You must acknowledge the RACGP as the acknowledge the Traditional Custodians of the lands and seas on which we work and live, and pay our respects to Elders, past, present and guidelines for patients with COVID-19 | iAcknowledgementsThe update of these guidelines has been undertaken by The Royal Australian College of General Practitioners (RACGP) in collaboration with the HealthPathways Community. A clinical pathway has been written alongside this guidance to reflect local environments and services, and is published on local HealthPathways sites. This collaboration aims to support general practice teams to collaborate with local hospital services in the care of patients with RACGP acknowledges the work of the National COVID-19 Clinical Evidence Taskforce (of which the RACGP is a member)

4 In developing living guidelines and clinical flowcharts for the assessment and management of guidelines for patients with COVID-19 | iiContentsBackground 1 Vaccination status 2 Patient results and notification 2 Patient triage and clinical care overview 4 Home-care suitability assessment 5 Determining the appropriate monitoring protocol 9 Managing symptoms and medicines 16 Ongoing patient symptom monitoring 18 Escalating care 20 Conducting telehealth consultations 21 Conducting face-to-face consultations 22De-escalating care 24 Providing release from isolation 24 Vaccination following infection 25 Handover to a patient s usual GP 25 General advice for the care of pregnant or breastfeeding patients 26 General advice for the care of children with COVID-19 27 Additional resources 28 References 29 Home-care guidelines for patients with COVID-19 | 1 Background People who test positive for COVID-19 are most likely to only experience mild symptoms (80% of patients ) and recover without requiring special treatment or hospitalisation, especially if fully guide contains information for general practitioners (GPs) who are providing home-based care in a private residential home (including public or community housing)

5 , in residential aged care facilities and supported accommodation, for patients who have tested positive for COVID-19 but are not deemed to be high risk for severe disease or for patients with COVID-19 in their homes allows the provision of appropriate holistic care, minimises the impact on the healthcare system, frees up hospital beds for patients with severe illness (or who otherwise require hospitalisation) and minimises the risk of transmission within a hospital processes that facilitate timely and adequate communication, and clinical handover to GPs and their teams, should be in place when a COVID-19 -positive patient is discharged from hospital into home care, or where a hospital -led program or health service is arranging GP states/territories will have models of care that allow remote supervision of patients by GPs, which cover escalation pathways for intervention and admission to hospital or hospital -led programs, if required.

6 These models of care ensure patients receive the required services and supports based on their healthcare requirements, care preferences and other document provides general guidance for GPs, and should be used to support any local or other more contemporaneous advice, such as the National COVID-19 Clinical Evidence Taskforce guidelines and HealthPathways. It can be used in conjunction with Managing COVID-19 at home with assistance from your GP A guide, action plan and symptom diary for | Home-care guidelines for patients with COVID-19 Vaccination statusThe Communicable Diseases Network Australia (CDNA) National guidelines for public health units state that fully vaccinated refers to a person who is 14 days following receipt of the final dose of a primary course of COVID-19 vaccine approved and recognised by the Therapeutic Goods Administration (TGA).

7 1 All vaccines currently available for use in Australia require a minimum of two doses. The Australian Technical Advisory Group on Immunisation (ATAGI) recommends that individuals who are severely immunocompromised receive a third vaccine dose as part of their primary course, 2 6 months after their second dose. It is recommended that adults aged 18 years and older receive a booster dose six months after their second protection is 7 14 days after the final dose in the the purposes of public health orders in Australia, two doses of a COVID-19 vaccine are required. While people vaccinated against COVID-19 can still contract the SARS-CoV-2 virus, they are significantly less likely to suffer severe disease or require hospitalisation. While vaccination significantly reduces the risk of severe disease and hospitalisation, care must be provided based on clinical presentation and medical and social risk factors.

8 Ensure you are up to date with the latest clinical guidance on COVID-19 vaccines in Australia, as these are updated frequently. Patient results and notificationGPs might become aware of one of their patients being diagnosed with COVID-19 through the receipt of: a positive result following GP-initiated testing notification from the local public health unit/state or territory Department of Health after testing initiated by another agency a local health service seeking to arrange home-based care discharge notification regarding a patient hospitalised with COVID-19 notification by the patient or their is a notifiable disease in all states and territories. Pathology providers who process the SARS-CoV-2 nasopharyngeal testing are responsible for notifying the local public health unit (or relevant authority) of a positive result.

9 The methods of notification of a positive result to a patient and their GP vary significantly across states and local services. These methods are likely to continue to change as the care of this condition moves further into general guidelines for patients with COVID-19 | 3 Rapid antigen testingThe TGA has approved a number of COVID-19 point-of-care test kits and COVID-19 self-tests for use in workplaces, industry and the home. These are readily available through pharmacies and best use of these tests is still being determined, as they have lower sensitivity and specificity than laboratory polymerase chain reaction (PCR) testing. Symptomatic patients must not rely on a rapid antigen test (RAT) for exclusion of COVID-19 because of the risk of a false-negative result. The use of these tests might be most appropriate for frequent repeated surveillance testing of asymptomatic people with workplace exposure risks.

10 However, with the likely widespread availability of tests following this approval, RATs are likely to be used in the community for a range of reasons, whether or not appropriate, including self-testing by people with COVID-19 first notification of a patient s possible COVID-19 -positive status might be through self-reporting of their RAT a patient reports a positive result from a point-of-care test or self-test, this must be confirmed with PCR testing. Ensure these patients are immediately referred for COVID-19 PCR testing at the same time as ensuring any urgent clinical needs are addressed. The patient should be managed on the assumption they will return a positive result on PCR testing, and appropriate personal protective equipment (PPE) should be worn when consulting these patients .


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