If a patient has been assessed as requiring and suitable for home care, a management plan will need to be put in place to ensure the safety of the patient and other household members. This might (but not always) include a formal collaboration between the GP and a hospital-led service,* and should include the following:
- Establishing the date of symptom onset as day zero (or the date of testing, if asymptomatic)
- Educating the patient about indicators for disease progression; in particular, discussing the risk of deterioration in the second week after symptom onset
- The use of a TGA approved pulse oximeter may be considered in patients with risk factors for deterioration and, if utilised, are of most benefit where there is regular clinician check-in with the patient and as part of broader symptom monitoring
- Educating the patient and other household members about infection prevention and control procedures to stop the spread of COVID-19
- Determining the frequency of contact and follow up required, as determined by the monitoring protocol and as per changes in symptoms, the stage of the illness, and individual patient characteristics and concerns
- Providing information on where, when and how to seek emergency medical assistance (refer to ‘Escalating care’) to the patient, their caregivers and/or other household members
- Establishing who will manage the patient if the treating GP is not available
- Consider the availability of other GPs/nurses in the practice
- Provide contact details for after-hours/medical deputising services or other after-hours services formed in collaboration with the local health district/network
- Provide details of the National Coronavirus Helpline (1800 020 080) or service engaged for additional care of COVID-19 patients in your jurisdiction, and refer to the online healthdirect COVID-19 symptom checker
- If the patient has low English literacy, they can access in-language assistance by calling the National Coronavirus Helpline on 1800 020 080 and selecting the option for interpreter services.
- Creating an action plan for the patient and their carers to monitor their symptoms and know when and how to escalate support
- Discussing the care arrangement for other household members and extended family/community members, if the entire household test positive
- Determining if the patient has an advance care directive/plan and/or enduring power of attorney in the event the patient becomes unwell and cannot express their care wishes
- Uploading a shared health summary and sending a medical summary to the hospital- led COVID-19 service (if admitted to such) if the patient has a My Health Record
- Providing the patient written materials reinforcing matters discussed, including monitoring and managing symptoms, medicine management, infection prevention and control procedures, contact details for the practice and contact details for if the treating GP is not available and how and when to seek emergency assistance. The relevant hospital or commissioned health service might already have appropriate material to provide to patients, or you can use the RACGP’s guide, action plan and symptom diary for patients. This can be emailed or printed and picked up by a support person for delivery to the patient’s home
*In a rural or remote setting, it might be appropriate to collaborate with all local health service providers (with the patient’s consent), including the local hospital, ambulance service and community nurses, in managing COVID-19- positive patients in the community. This ensures all service providers are aware of the patients under surveillance and are part of the support structure.
Additional considerations when providing GP shared care for patients admitted to a hospital-led program
Additional considerations when developing a management plan:
- The patient should be informed that, as the GP, you are providing care for their pre-existing conditions and mental health – all COVID-19-related issues are managed by the hospital-led program team.
- The patient should have the contact details of the hospital-led program and know how to contact them, if needed.
- The patient should be educated that, if their COVID-19 symptoms worsen, they need to contact the hospital-led program (or 000, if necessary).
- The patient may have access to self-monitoring devices, such as pulse oximeters, through the hospital-led program. The patient should be educated by the program on how to use these devices and demonstrate an understanding of what results should be reported and to who.
Additional considerations when caring for patients from CALD communities
If the patient has low English literacy, they can access in-language assistance from the National Coronavirus Helpline by calling 1800 020 080 and selecting the option for interpreter services.
Patients, including those from CALD communities, might be fearful of going to hospital (if escalation is required) without the presence of other family members if COVID-19 restrictions are in place. Encourage patients and their families to ask questions about potential outcomes of COVID-19 early in the diagnosis so that they are fully informed prior to making decisions about their care.
Make sure the patient has access to their regular medicines.
Prescriptions can now be sent directly to patients via SMS or email using electronic prescribing (or uploaded to their Active Script List if they are enrolled). Read more about electronic prescribing and access fact sheets for GPs and patients on the RACGP website. Patients can forward their electronic prescription to their local pharmacy for dispensing and request the medicine is delivered, or forward to a family member or carer to pick up.
Patients can also arrange for a family member or carer to pick up a paper prescription from the practice and have it delivered (ensuring isolation requirements are maintained).
Mental health support
- Assess the patient’s mental health and general wellbeing and facilitate additional COVID-19 support if needed:
- In your language resources to provide support for people from CALD communities have been developed by the Transcultural Mental Health Centre
- Patients from CALD communities can also access language support through the National Coronavirus Helpline by calling 1800 020 080 and selecting the option for interpreter services.
- Encourage patients to remain physically active within their homes during isolation (and within the limitations of their symptoms and disease severity).
- Encourage patients to maintain social contact through phone or video calls. Virtual and phone-based support might be available through local community groups for isolated patients.
- Provide culturally appropriate care.
Using apps and digital tools to support patient care
A number of apps have been developed to support the care of patients with COVID-19, including remote monitoring.
These apps could be used by hospital-led programs or public health units. Speak with your local public health unit to see if apps are being used to support patients in your area.
If your practice is participating in remote monitoring of patients using digital tools, see the RACGP’s mHealth in general practice resource to ensure effective and secure use of mobile devices.
Tracking spreadsheet for COVID-19 patient cohort
You or your practice might consider using a patient tracking spreadsheet to give visibility over your COVID-19 patient cohort and tracking their progress.
An example template is available here
, and can be adapted for your use.
In addition to all clinical consultations, assessments and investigations, GPs should keep a record of all communications with patients and other parties.
|Box 6. COVID-19 symptoms1
|The most commonly reported symptoms of COVID-19
- Loss of taste and/or smell
- Sputum/respiratory secretions
- Sore throat
- Shortness of breath