Health services administration

Uday N Yadav · Rosemary Wyber · Fiona Cornforth (Wuthathi/Maluilgal) · Raymond W Lovett (Wongaibon/Ngiyampaa)

Meeting demand for higher care level support will require a larger aged care workforce particularly in regional and remote areas

Johannes Schwabe · Gillian E Caughey · Steve L Wesselingh · Craig Whitehead · Renuka Visvanathan · Keith Evans · Maria C Inacio

Vishnu Khanal · Deborah J Russell · John Wakerman

To the Editor: Holland and colleagues reported on the Alfred Health post‐COVID‐19 service experience with the health of patients who had previously been hospitalised, or managed in a hospital‐in‐the‐home setting, with COVID‐19.1 Participants responded to an invitation to register for follow‐up, and then completed a questionnaire. The study also included a separate group (13% of the cohort) who were not necessarily admitted to Alfred Health but lived in the Alfred Health catchment — and might have been managed as outpatients or inpatients in another service but were referred by their local doctors to a specialist clinic targeted for patients with symptoms after initial COVID‐19, and subsequently completed the questionnaire. Sixty per cent of respondents had at least one persistent symptom at eight weeks. The study reported apparently high prevalences of other symptoms, such as post‐traumatic stress disorder in 23%. These results are derived from their cohort and may not be generally applicable. The authors caution: “We could not distinguish between new symptoms and those attributable to other health conditions. Our study did not include a contemporary control group”.1 More importantly, there was no control group of patients hospitalised from non‐COVID‐19 viral illness (with sufficient severe illness to lead to almost 5% spending time in an intensive care unit), who were then concentrated by an invitation, and then sufficiently motivated to fill out a questionnaire. Plausibly in such a group, at eight weeks, 60% would report at least one persistent symptom. Interpretation of their results is also obscured by the patients referred from the community, who came from a bigger population of patients with COVID‐19 concentrated to include only those who sought or agreed to a referral to a specialist follow‐up clinic. The authors wisely identified weaknesses and they should be applauded for their review of their experience. More definitive conclusions about higher rates of persisting ill health caused by COVID‐19 (in comparison to similarly severe infectious illness) might be achieved if they can follow this up — as they perhaps recognise — with a prospective analytic design in a cohort of patients presenting with similar severity of viral illness comparing those with and without COVID‐19 over the long term.

Jeremy L Millar

In reply: We thank Millar1 for taking the time to respond to our article,2 which details an evaluation of the Alfred Health post‐COVID‐19 clinical service established in June 2020. At that time we, like many health services around the world, faced the challenge of providing ongoing clinical management for patients with persistent and debilitating symptoms following SARS‐CoV‐2 infection, with little evidence to guide service provision or model of care. As there were no data to guide patient selection, we invited all patients with a diagnosis of COVID‐19 who had been managed by our health service (in hospital or in the community) to opt in if they perceived a need for ongoing care. This allowed us to quantify demand, as identified by patients who were affected. Our data confirm that a small proportion (6%) of individuals had persistent symptoms of long COVID that required medical and allied health specialist management. We consider this opt in approach a strength of our report; estimates of ongoing care needs following COVID‐19 vary enormously,3 and our data suggest that demand may be at the lower end of those estimates. As the pandemic progressed and more people with COVID‐19 were managed in the community, we adapted to the clinical needs of our patients by accepting referrals from general practice. We agree that there are limitations to our report, which are inherent in its nature as a service evaluation. We did not aim to provide epidemiological data on the prevalence or characteristics of long COVID; rather, we aimed to document the proportion of our patients following COVID‐19 who identified ongoing care needs, and to describe their characteristics. The recent federal parliamentary inquiry into long COVID4 states that “The role of specific long COVID clinics as a resource for primary health providers is very important to allow adequate services for major complications” and calls for the establishment of multidisciplinary long COVID clinics in selected public hospitals. We hope that our experience might be informative for other health services who are seeking to provide care for this small but important group of patients.

Anne Holland · Simone Dal Corso

Aboriginal and Torres Strait Islander communities remain invisible in data which is used to inform policy, clinical models of care, health services and initiatives

Courtney Ryder · Sadia Hossain · Leanne Howard · Julia Severin · Rebecca Ivers

The proportion of births to Victorian women with obesity rose during 2010–2019, particularly in regional areas

Yvonne E Baker · Glyn Teale · Vidanka Vasilevski · Alemayehu Mekonnen · Linda Sweet

Colleges must direct efforts to centre the development of critical allyship to support Indigenous peoples

Paul Saunders

Queensland Health must act on the coronial recommendations to avoid more preventable deaths in Doomadgee

Avelina Tarrago (Wangkamahdla) · Ella Veit‐Prince · Claire E Brolan

Improving their social and emotional wellbeing could help reduce the number of Aboriginal people in Australian prisons by reducing recidivism

Pat Dudgeon (Bardi) · Ee Pin Chang · Joan Chan · Carolyn Mascall · Gillian King (Noongar) · Jemma R Collova · Angela Ryder (Noongar)

Cardiologists require competency and confidence in managing not only deteriorating but also end of life, heart failure

Dominica Zentner · Vithoosharan Sivanathan · Jennifer Philip · Natasha Smallwood