Primary health care in the face of post-COVID-19 syndrome
an integrative review
DOI:
https://doi.org/10.5712/rbmfc20(47)3644Keywords:
Primary health care, Family practice, Post-acute COVID-19 syndromeAbstract
Introduction: Primary Health Care has played a fundamental role in the care of patients with post-COVID-19 syndrome. Post-COVID-19 syndrome is characterized as a syndrome that comprises the emergence of signs and symptoms after SARS-CoV-2 infection in the acute, ongoing, and post- infection phases. Objective: To understand the mechanisms developed to improve management in the comprehensive care of patients with post- COVID-19 syndrome in Primary Health Care, in dialogue with the Brazilian and German health systems. Methods: A theoretical and exploratory search was carried out in two databases (PubMed and Web of Science) on the management of post-COVID-19 syndrome, considering the challenges and potentialities of Primary Health Care in Brazil and Germany for the adequate management of patients with this condition. Results: Post-COVID-19 syndrome affects multiple organs and systems, requiring management based on multimodal and biopsychosocial models, considering both medical and non-medical therapeutic approaches. Although Primary Health Care coverage has improved in Brazil and Germany regarding the treatment of this syndrome, some challenges remain. Conclusions: Improving the management of post-COVID-19 syndrome within Primary Health Care requires a multifaceted approach. This involves advancing the professional understanding of the syndrome’s complex and evolving pathophysiological mechanisms, establishing and regularly updating evidence-based clinical guidelines for managing persistent symptoms, and developing structured referral and counter-referral systems. Furthermore, healthcare professionals must be trained to assist in the early diagnosis and appropriate referral of patients with post-COVID-19 syndrome in Primary Health Care. These efforts must be adapted to local healthcare realities, emphasizing intersectoral collaboration and the integration of physical, psychological, and social dimensions in the provision of comprehensive care.
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Schmidt KFR, Gensichen J, Gehrke-Beck S, Kosilek RP, Kühne F, Heintze C, et al. Management of COVID-19 ICU-survivors in primary care: a narrative review. BMC Fam Pract. 2021;22(1):160. https://doi.org/10.1186/s12875-021-01464-2 DOI: https://doi.org/10.1186/s12875-021-01464-2
Kaswa R, Govender I. Novel coronavirus pandemic: a clinical overview. S Afr Fam Pract. 2020;62(1):e1-e5. https://doi. org/10.4102/safp.v62i1.5123 DOI: https://doi.org/10.4102/safp.v62i1.5123
Greenhalgh T, Knight M, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. https://doi.org/10.1136/bmj.m3026 DOI: https://doi.org/10.1136/bmj.m3026
Pettigrew LM, Kumpunen S, Mays N. Primary care networks: the impact of covid-19 and the challenges ahead. BMJ. 2020;370:m3353. https://doi.org/10.1136/bmj.m3353 DOI: https://doi.org/10.1136/bmj.m3353
Venkatesan P. NICE guideline on long COVID. Lancet Respir Med. 2021;9(2):129. https://doi.org/10.1016/S2213- 2600(21)00031-X DOI: https://doi.org/10.1016/S2213-2600(21)00031-X
Ercole FF, Melo LSD, Alcoforado CLGC. Revisão integrativa versus revisão sistemática. Rev Min Enferm. 2014;18(1):9-12. https://doi.org/10.5935/1415-2762.20140001 DOI: https://doi.org/10.5935/1415-2762.20140001
Botelho LLR, Cunha CC, Macedo M. O método da revisão integrativa nos estudos organizacionais. Gest Soc. 2011;5(11):121- 36. https://doi.org/10.21171/ges.v5i11.1220 DOI: https://doi.org/10.21171/ges.v5i11.1220
Stetler CB, Brunell M, Giuliano KK, Morsi D, Prince L, Newell-Stokes V. Evidence-based practice and the role of nursing leadership. J Nurs Adm. 1998;28(7-8):45-53. https://doi.org/10.1097/00005110-199807000-00011 DOI: https://doi.org/10.1097/00005110-199807000-00011
Brasil. Ministério da Saúde. Recomendação nº 013, de 26 de maio de 2022: orientações sobre o manejo e acompanhamento de pessoas com condições pós-COVID-19. Brasília: Ministério da Saúde; 2022.
Brasil. Ministério da Saúde. Nota Técnica nº 57/2023 – DGIP/SE/MS: atualizações acerca das “condições pós-COVID” no âmbito do Ministério da Saúde. Brasília: Ministério da Saúde; 2023.
Brasil. Ministério da Saúde. Orientações sobre diagnóstico e tratamento de pacientes com as condições pós-COVID. Brasília: Ministério da Saúde; 2025.
Koczulla AR, Ankermann T, Behrends U, Berlit P, Brinkmann F, Frank U, et al. S1-Leitlinie Long/Post-COVID [Stand: 30.05.2024; gültig bis: 29.05.2025]. AWMF-Register Nr. 020-027 [Internet]. Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften; 2024 [acessado em 21 ago. 2025]. Disponível em: https://www.awmf.org/leitlinien/detail/ ll/020-027.html
Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Syst Transit. 2020;22(6):1-272.
Soriano JB, Murthy S, Marshall JC, Relan P, Diaz JV; WHO Clinical Case Definition Working Group on Post-COVID-19 Condition. A clinical case definition of post-COVID-19 condition by a Delphi consensus. Lancet Infect Dis. 2022;22:e102-7. https://doi.org/10.1016/s1473-3099(21)00703-9 DOI: https://doi.org/10.1016/S1473-3099(21)00703-9
Förster C, Colombo MG, Wetzel AJ, Martus P, Joos S. Persisting symptoms after COVID-19—prevalence and risk factors in a population-based cohort. Dtsch Arztebl Int. 2022;119(10):167-74. https://doi.org/10.3238/arztebl.m2022.0147 DOI: https://doi.org/10.3238/arztebl.m2022.0147
Esposito S, Principi N, Azzari C, Cardinale F, Di Mauro G, Galli L, et al. Italian intersociety consensus on management of long covid in children. Ital J Pediatr. 2022;48(1):42. https://doi.org/10.1186/s13052-022-01233-6 DOI: https://doi.org/10.1186/s13052-022-01233-6
van Kessel SA, Olde Hartman TC, Lucassen PL, van Jaarsveld CH. Post-acute and long-COVID-19 symptoms in patients with mild diseases: a systematic review. Fam Pract. 2022;39(1):159-67. https://doi.org/10.1093/fampra/cmab076 DOI: https://doi.org/10.1093/fampra/cmab076
Wolf S, Zechmeister-Koss I, Erdös J. Possible long COVID healthcare pathways: a scoping review. BMC Health Serv Res. 2022;22(1):1076. https://doi.org/10.1186/s12913-022-08384-6 DOI: https://doi.org/10.1186/s12913-022-08384-6
Duerlund LS, Shakar S, Nielsen H, Bodilsen J. Positive predictive value of the ICD-10 diagnosis code for long-COVID. Clin Epidemiol. 2022;14:141-8. https://doi.org/10.2147/CLEP.S344515 DOI: https://doi.org/10.2147/CLEP.S344515
Edgeworth JD, Batra R, Nebbia G, Bisnauthsing K, MacMahon E, Sudhanva M, et al. Translational research in the time of COVID-19—dissolving boundaries. PLoS Pathog. 2020;16(9):e1008898. https://doi.org/10.1371/journal.ppat.1008898 DOI: https://doi.org/10.1371/journal.ppat.1008898
Barshikar S, Laguerre M, Gordon P, Lopez M. Integrated care models for long coronavirus disease. Phys Med Rehabil Clin N Am. 2023;34(3):689-700. https://doi.org/10.1016/j.pmr.2023.03.007 DOI: https://doi.org/10.1016/j.pmr.2023.03.007
Brennan A, Broughan JM, McCombe G, Brennan J, Collins C, Fawsitt R, et al. Enhancing the management of long COVID in general practice: a scoping review. BJGP Open. 2022;6(12):bjgpo.2021.0178. https://doi.org/10.3399/bjgpo.2021.0178 DOI: https://doi.org/10.3399/BJGPO.2021.0178
Chou R. Long COVID definitions and models of care: a scoping review. Ann Intern Med. 2024;177(7):929-40. https://doi. DOI: https://doi.org/10.7326/M24-0677
org/10.7326/m24-0677
Curvelo RD, Ribeiro AC, da Silva André Uehara SC. Health care for patients with long COVID: a scoping review. Rev Esc Enferm USP. 2024;58:e20240056. https://doi.org/10.1590/1980-220X-REEUSP-2024-0056en DOI: https://doi.org/10.1590/1980-220x-reeusp-2024-0056en
Dillen H, Bekkering G, Gijsbers S, Vande Weygaerde Y, Van Herck M, Haesevoets S, et al. Clinical effectiveness of rehabilitation in ambulatory care for patients with persisting symptoms after COVID-19: a systematic review. BMC Infect Dis. 2023;23(1):419. https://doi.org/10.1186/s12879-023-08374-x DOI: https://doi.org/10.1186/s12879-023-08374-x
Herman E, Shih E, Cheng A. Long COVID: rapid evidence review. Am Fam Physician. 2022;106(5):523-32.
Katz GM, Bach K, Bobos P, Cheung A, Décary S, Goulding S, et al. Understanding How Post–COVID-19 Condition Affects Adults
and Health Care Systems. JAMA Health Forum. 2023;4;(7):e231933. https://doi.org/10.1001/jamahealthforum.2023.1933 DOI: https://doi.org/10.1001/jamahealthforum.2023.1933
Li J, Zhou Y, Ma J, Zhang Q, Shao J, Liang S, et al. The long-term health outcomes, pathophysiological mechanisms and multidisciplinary management of long COVID. Signal Transduct Target Ther. 2023;8(1):416. https://doi.org/10.1038/s41392- 023-01640-z DOI: https://doi.org/10.1038/s41392-023-01640-z
Mansell V, Hall Dykgraaf S, Kidd M, Goodyear-Smith F. Long COVID and older people. Lancet Healthy Longev. 2022;3(12):e849-e854. https://doi.org/10.1016/S2666-7568(22)00245-8 DOI: https://doi.org/10.1016/S2666-7568(22)00245-8
Zifko U, Guendling K, Seet R, Kasper S. Management of cognitive impairment associated with post-COVID-19 syndrome: recommendations for primary care. Front Pharmacol. 2024;15:1338235. https://doi.org/10.3389/fphar.2024.1338235 DOI: https://doi.org/10.3389/fphar.2024.1338235
Garcia FL, Socal M. Impacts of the 2017 Brazilian National Primary Care Policy on public primary health care in Rio de Janeiro, Brazil. Cad Saúde Pública. 2022;38(5):e00219421. https://doi.org/10.1590/0102-311XEN219421 DOI: https://doi.org/10.1590/0102-311xen219421
Wangler J, Jansky M. How can primary care benefit from digital health applications? – a quantitative, explorative survey on attitudes and experiences of general practitioners in Germany. BMC Digit Health. 2024;2:14. https://doi.org/10.1186/s44247- 024-00068-x DOI: https://doi.org/10.1186/s44247-024-00068-x
Górska A, Canziani LM, Rinaldi E, Pana ZD, Beale S, Bai F, et al. Learning from post-COVID-19 condition for epidemic preparedness: a variable catalogue for future post-acute infection syndromes. Clin Microbiol Infect. 2025;31(3):380-8. https:// doi.org/10.1016/j.cmi.2024.12.001 DOI: https://doi.org/10.1016/j.cmi.2024.12.001
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