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德国全科医生管理新冠后综合征的经验:一项定性访谈研究。

German general practitioners' experiences of managing post-COVID-19 syndrome: A qualitative interview study.

机构信息

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Eur J Gen Pract. 2024 Dec;30(1):2413095. doi: 10.1080/13814788.2024.2413095. Epub 2024 Oct 21.

Abstract

BACKGROUND

The management of the long-term sequelae of coronavirus disease 2019 (COVID-19) infection, known as post-COVID-19 syndrome (PCS), continues to challenge the medical community, largely owing to a significant gap in the understanding of its aetiology, diagnosis and effective treatment.

AIM

To examine general practitioners' (GPs) experiences of caring for patients with PCS and to identify unmet care needs and opportunities for improvement.

DESIGN AND SETTING

This study follows a qualitative design, using in-depth semi-structured telephone interviews with GPs ( = 31) from across Germany.

METHOD

Interviews were audio-recorded, transcribed verbatim and analysed using qualitative content analysis.

RESULTS

GPs reported that they were often the first point of contact for patients with persistent symptoms following SARS-CoV-2 infection, with symptoms typically resolving within weeks. While ongoing symptomatic COVID-19 is perceived to be more common, the relevance of PCS to GP practices is considerable given its severe impact on patients' functioning, social participation and the substantial time required for patient care. GPs coordinate diagnosis and treatment but face challenges because of the unclear definition of PCS and difficulties in attributing symptoms, resulting in a cautious approach to ICD-10 coding. Interviewees highlight lengthy diagnostic pathways and barriers to accessing specialist care.

CONCLUSION

The findings confirm the high functional limitations and psychosocial burden of PCS on patients, and the central role of GPs in their care. The study suggests a need for further research and health policy measures to support GPs in navigating diagnostic uncertainty, interprofessional communication and the limited evidence on effective treatments.

摘要

背景

新冠病毒病 2019(COVID-19)感染的长期后遗症的管理,即新冠后综合征(PCS),仍然对医学界构成挑战,主要是因为对其病因、诊断和有效治疗的理解存在重大差距。

目的

研究全科医生(GP)在照顾 PCS 患者方面的经验,确定未满足的护理需求和改进机会。

设计和设置

本研究采用定性设计,对德国各地的全科医生( = 31)进行深入的半结构化电话访谈。

方法

访谈进行了录音,逐字转录,并使用定性内容分析进行分析。

结果

全科医生报告说,他们通常是继 SARS-CoV-2 感染后出现持续症状的患者的第一接触点,症状通常会在几周内缓解。虽然人们认为持续性 COVID-19 更为常见,但鉴于 PCS 对患者功能、社会参与和患者护理所需时间的严重影响,它对全科医生实践具有相当大的相关性。全科医生协调诊断和治疗,但面临挑战,因为 PCS 的定义不明确,以及难以将症状归因于 PCS,导致对 ICD-10 编码持谨慎态度。受访者强调了冗长的诊断途径和获得专科护理的障碍。

结论

研究结果证实了 PCS 对患者的高功能限制和心理社会负担,以及全科医生在其护理中的核心作用。该研究表明,需要进一步研究和卫生政策措施,以支持全科医生应对诊断不确定性、跨专业沟通以及有效治疗的有限证据。

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