If a patient tests positive for COVID-19, the severity of their illness (refer to boxes 1 and 2) will need to be determined to ensure appropriate care is provided in the appropriate location. Local factors, such as remoteness, resources, escalation pathways, local clinician expertise and workload, and access to health services, will influence this decision, as will social factors, such as appropriateness of housing, ability to self-isolate, access to a carer and patient preference. Many regions will have local processes documented on their HealthPathways website.
Patients should only be referred to GPs from hospitals, triage services or other care providers after the GP has accepted care for the patient. Patients should only be general advice to see their GP for ongoing care during their acute infectious period, if the GP has been consulted and accepted care, and a handover of that patient is provided. Patients might present to a GP following a positive home RAT.
Most patients with mild COVID-19 will not require additional support while recovering at home. Options for the location of care for patients with mild and moderate COVID-19, who require additional support or who are at risk of disease progression can include:
- care in a private home, residential facility or temporary accommodation – using telehealth and remote monitoring, and face-to-face clinical contact, if required by their GP, a commissioned health service or a hospital-led service
- admission into an in-home hospital-led program, such as Hospital in the Home (HITH) or ‘virtual’ HITH
- admission to hospital (for those at higher risk, including the elderly and those with chronic disease or compromised immunity).
A decision regarding home care will be based on the processes of the local public health unit, local hospital service or other jurisdictional agency, as well as the patient’s symptom severity, risk factors and home situation, and a GP’s ability to provide the necessary care.
GPs who are not involved in COVID-19 management processes should still manage the patient’s usual healthcare. It is important to confirm who is clinically responsible for the patient in such circumstances. It is also important for the GP to be aware of the jurisdictional arrangements regarding whether a patient being managed through the hospital-led service is classified as an inpatient or outpatient. If classified as an inpatient, the GP is not able to provide Medicare Benefits Schedule (MBS)-funded services related to COVID-19 management during that admission, and could face some challenges proving that any care provided is unrelated to their admission. For this reason, many hospital-led services are using an outpatient model, which enables ongoing GP support. Arrangements might differ across jurisdictions or change as COVID-19 community care evolves. Depending on where your practice is, there could be scope for MBS services to be provided for non-COVID-19-related services for admitted patients.
Before providing care to patients admitted to hospital (whether physically or under virtual care models), or as part of hospital-led programs, GPs should check with the hospital and their local primary health network (PHN) about any specific local arrangements for MBS billing involving these patients, both for COVID-19- and non-COVID-19-related issues. Information is also available from the Australian Government Department of Health via its AskMBS service, accessible via askMBS@health.gov.au