More than a quarter (26.7%) of GP practices in England have never used the clinical codes for long Covid since their introduction in November 2020, a study has shown.
An analysis of 58 million patient records, published in the British Journal for General Practice (BJGP), found that as of 25 April 2021 there were 23,273 (0.04%) patients with a recorded code indicative of long Covid diagnosis.
The study also found that practices using SystemOne were much more likely (44.2%) to not use the codes, when compared with practices using EMIS (15.1%).
The study authors suggested that this difference may be related to the location of the practices, as ‘EMIS covers a high proportion of the London population, while TPP covers a high proportion of the East of England’.
Coding was higher in London (55.6 per 100,000 people) compared with the East of England (20.3).
The series of clinical codes which indicate a diagnosis of long Covid were introduced in November 2020 and were made available in EMIS in January 2021. They include two diagnostic codes, three referral codes, and 10 assessment codes.
The study authors noted that appropriately coding long Covid is ‘critical for ongoing patient care, research into the condition, policy making, and public health resource planning’.
Coding ‘extremely low’
The prevalence of long Covid codes in primary care identified in the study is ‘extremely low’ when compared to the most recent survey data, the study said.
Numbers published last month (4 June) by the Office for National Statistic (ONS) showed that around 1 million people self-reported experiencing long Covid symptoms lasting more than four weeks.
A separate paper found that as many as one in six (17%) middle-aged people who reported having had a Covid-19 infection also reported having long Covid symptoms.
This disparity could be attributed to patients not yet presenting to primary care and different clinicians holding different criteria for diagnosis, the authors of the new study said.
It added that the design of the electronic systems may be a factor, such as the way in which the codes can be selected for entry onto a patient record.
Additionally, the varied rate across different locations ‘strongly suggests that clinicians’ coding practice is inconsistent’.
It added: ‘Despite these issues around correct recording of clinicians’ diagnoses, there also remains a strong possibility that clinicians are not currently diagnosing their patients as having long Covid.’
Meanwhile, NHS Digital’s decision not to include the term ‘long Covid’ in its clinical definition of Covid symptoms lasting four to 12 weeks – and therefore, to omit the term from the diagnostic codes – may point to a ‘mismatch between formal clinical terminology’ and everyday language used by patients and clinicians.
The study authors suggested the terminology be either updated or communicated to frontline clinicians.
