Self management and supported self management

Managing the long-term effects of COVID-19 (SIGN/NICE/RCGP)
Healthcare Improvement Scotland

Related information: Clinical case definitions

Rationale

There was very little evidence on interventions, but the panel agreed that everyone should have self management support and information. There was a lack of COVID-19-specific evidence on managing many of the common symptoms related to COVID-19, such as fatigue, dizziness and cognitive problems (such as brain fog), but the panel agreed that support, such as setting achievable goals, should be tailored to the person’s needs. Patient organisations and online support groups can help to support self management. The NHS websites Coronavirus (COVID-19): General advice | NHS inform and Your COVID recovery were highlighted as a potential source of reliable up-to-date information and support.

The panel agreed that support to return to education or work, such as setting achievable goals, should be tailored to the person’s needs. This might involve support to work or study at home, flexible working or a phased return.

For the November 2021 update, the panel heard expert testimonies from Stark 2021 and Whittaker 2021 describing that absence from or poor performance in education was associated with poor outcomes for children and young people with ongoing symptomatic COVID‑19 or post-COVID-19 syndrome. The panel agreed that this would also apply to adults returning to work or education. Healthcare professionals should be aware that people who are struggling to return to work or education may have symptoms that persist for longer than other people and may need additional support.

Further advice on returning to work can be found in the Society for Occupational Health Medicine guidance on COVID-19 return to work guide for recovering workers and COVID-19 return to work guide for managers.

Recommendations

Give advice and information on self management to people with ongoing symptomatic COVID-19 or post-COVID-19 syndrome starting from their initial assessment. This should include:

  • ways to self manage their symptoms, such as setting realistic goals
  • who to contact if they are worried about their symptoms or they need support with self management
  • sources of advice and support, including support groups, social prescribing, online forums and apps
  • how to get support from other services, including social care, housing, and employment, and advice about financial support
  • information about new or continuing symptoms of COVID-19 that the person can share with their family, carers and friends (see Advice and resources for commonly reported symptoms and signs). 
  This content is derived from the Scottish Government's Implementation Support Note.

Sources of direct advice and support [including psychosocial recovery support]

Resources on self management

Peer support (patient led and independent views expressed are their own)

  • Long Covid Scotland: signposts people with long-term effects of COVID-19 to support, advocacy, resources and opportunities to actively participate in research

Employment and return to work

Finding local community resources
  This content is derived from the Scottish Government's Implementation Support Note.

Primary care teams should have rapid access to support in local communities, including local patient groups, community based rehabilitation services, and recourse to usual primary and community care pathways, including physiotherapy, occupational therapy, speech and language, dietetics, podiatry, long term condition management, pain management and social support.

Where possible, it would be beneficial for this to be accessible directly by self-referral from patients. A single point of contact can appropriately involve suitable services. Community link workers, pharmacists and mental health workers can also provide support as part of the extended multi-disciplinary team.

Chest Heart & Stroke Scotland: Long COVID Support Service

Practices can refer people with, or suspected to have long-term effects of COVID-19, into the Chest Heart & Stroke Scotland ‘Long Covid Support service’ – this service supports people with long-term effects of COVID-19 whether they have been hospitalised or not and is built on the existing Hospital to Home service currently operating in a number of health boards for respiratory conditions.  It provides support and pro-active advice around self management while awaiting clinical appointments, encouraging self management and recovery and to take on the non-complex cases.
Explain to people that it is not known if over-the-counter vitamins and supplements are helpful, harmful or have no effect in the treatment of the new or continuing symptoms of COVID-19.
Support people in discussions with their employer, school or college about returning to work or education, for example by having a phased return. For advice on returning to work, follow national guidance.

Rationale

The panel were concerned that people are buying over-the-counter vitamins and supplements that may not help with their symptoms. They agreed that it would be helpful to highlight the lack of knowledge in this area.

Info box

It is not known if over-the-counter vitamins and supplements are helpful, harmful or have no effect in the treatment of new or ongoing symptomatic COVID 19 or post-COVID-19 syndrome.

Implementation Support flowchart

See Implementation Support Flowchart page