Education of Medical Staff to Post Acute Covid susTained sYmptoms (EMPATY)

Evaluation of a Training and Support Intervention for General Practitioners Managing Patients With Persistent Symptoms Following a COVID-19 Episode

Evaluation of the effectiveness of a training and support intervention for general practitioners treating patients with persistent symptoms after a COVID-19 episode on the patients'quality of life at 3 months.

Apart from the objectivable sequelae of a severe COVID-19 episode, the pathophysiology of symptoms persisting several months after an acute COVID episode is not established. The investigators hypothesize that a substantial part of these symptoms are functional somatic disorders, defined by symptoms not explained by a lesion of the organ which they designate and which can benefit from an action on their cognitive and behavioural mechanisms including an adapted physical activity program. The frequency of these symptoms and their major impact justifies the development of an adapted care offer easily accessible, involving mainly general practitioners (GP). For example, the ARS has advocated for the development of "covid-long" support cells, whose role is to coordinate the management of patients with these symptoms by providing advice and referral to other professionals if necessary. Experience has shown that doctors are baffled by the very polymorphic symptomatology of these patients and often have difficulty managing their anxiety towards the symptoms. Primary Objective: To assess the effectiveness of GP training accompanied by a Covid Long Support Cell (CACL) to manage persistent somatic functional symptoms attributed to COVID-19 on the quality of life of patients at 3 months. The main criterion of evaluation will be the evolution of the SF-12 quality of life physical composite score at 3 months. Methods: Stepped wedge controlled randomized trial: randomization of the order in which CACL will receive the intervention. After an observation phase during which the follow-up of the patients will be done according to the usual management of the care, the training of the CACL (intervention) will take place over 36 weeks. The intervention will include: Training delivered to CACL staff and volunteer general practitioners: online theoretical courses and video capsules produced with actors, discussed with learners, an expert doctor and an expert patient. Reimbursement for each patient of 3 long consultations (1 hour) with a participating general practitioner and an assessment by an adapted physical activity teacher during the first month of the patient's participation. Follow-up of the patient by telephone interview at inclusion then at 1, 3 and 6 months after inclusion: physical and mental components of the SF-12, intensity of symptoms; healthcare consumption, work stoppage, physician satisfaction and patient experience, 1, 3 and 6 months. Study population: patients managed by one of the 6 CACL of Ile de France. Statistical Analysis: In order to detect a difference of at least 3 points in the mean composite physical score (PCS) SF-12 at 3 months with a power of 80%, the investigators plan to include 112 subjects per cluster (n = 6) i.e. 672 subjects in total. A total of 6 clusters will be considered with 7 periods of 6 weeks (1 observation period without training of healthcare teams and 6 training periods). The PCS of the SF-12 questionnaire at 3 months will be compared between the patients included before and after the training using a mixed linear regression taking into account the cluster effect of the randomization by the inclusion in the model of a random effect on the cluster and the adjustment on the PCS at baseline. The secondary objectives will also be analyzed using adequate mixed models depending on the type of variables analyzed, considering the cluster as a random effect.

Stepped wedge study : all GP will eventually receive the training during the study period, but the time of their training is randomly assigned

Patients followed by general practitioners with no specific education on long COVID or somatic symptom disorders

Patients followed by general practitioners who have received a training in long COVID and somatic symptom disorders diagnosis and treatment, with reimbursement of three long consultations

Change of physical component summary (PCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 3 months compared to the PCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The physical component summary (PCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better physical health functioning.

Change of physical component summary (PCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 1 month compared to the PCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The physical component summary (PCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better physical health functioning.

Change of physical component summary (PCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 6 months compared to the PCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The physical component summary (PCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better physical health functioning.

Change of mental component summary (MCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 1 month compared to the MCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The mental component summary (MCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better mental health functioning.

Change of mental component summary (MCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 3 months compared to the MCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The mental component summary (MCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better mental health functioning.

Change of mental component summary (MCS) of 12-Item Short-Form Health Survey (SF-12v2) - quality of life scale at 6 months compared to the MCS at the inclusion of the patient

Health-related quality of life variable measured using the Short Form Health Survey (SF-12v2): 12-item self-report that assesses physical and mental health related quality of life. The mental component summary (MCS) will be used. Normalized score ranges from 0 to 100, with higher scores indicating better mental health functioning.

Change of clinical global impression (CGI scores) of the patient at 1 month compared to the last available clinical evaluation

The CGI questionnaire is rated on a 7-point scale and score ranges range from 1 (very much improved) through to 7 (very much worse). Each component of the CGI is rated separately. The following components will be considered: fatigue, pain, breathing difficulties, attention and concentration problems, other persistent symptoms.

Change of clinical global impression (CGI scores) of the patient at 3 months compared to the last available clinical evaluation

The CGI questionnaire is rated on a 7-point scale and score ranges range from 1 (very much improved) through to 7 (very much worse). Each component of the CGI is rated separately. The following components will be considered: fatigue, pain, breathing difficulties, attention and concentration problems, other persistent symptoms.

Change of clinical global impression (CGI scores) of the patient at 6 months compared to the last available clinical evaluation

The CGI questionnaire is rated on a 7-point scale and score ranges range from 1 (very much improved) through to 7 (very much worse). Each component of the CGI is rated separately. The following components will be considered: fatigue, pain, breathing difficulties, attention and concentration problems, other persistent symptoms.

Inclusion Criteria: at least two symptoms attributed to COVID-19 (including fatigue, dyspnea, cognitive impairment or pain); persistent for more than 2 months; not explained by a diagnosis unrelated to COVID-19; a quality of life impairment considered significant by the patient. Exclusion Criteria: Refusal to participate in the study Under 18 years of age Persistent symptoms secondary to an objective sequelae from the initial episode of COVID-19. Neuropsychiatric disorder that may impair cognitive function prior to COVID-19 Medical contraindication to physical training (pericarditis or myocarditis...) Patient not affiliated with the social security system or under AME Patient under guardianship, guardianship or guardianship

Individual participant data (IPD) that underlie results in publication could be shared. IPD detailed in the protocol of a planned metaanalysis could be shared

Data sharing must be accepted by the sponsor and the PI based on a scientific project and scientific involvement of the PI team. Collaboration will be fostered. Data sharing must respect the agreements made with funders. Teams wishing obtain IPD must meet the sponsor and IP team to present scientific (and commercial) purpose, IPD needed, format of data transmission, and timeframe. Technical feasibility and financial support will be discussed before mandatory contractual agreement. Processing of shared data must comply with European General Data Protection Regulation (GDPR).