Characteristics of post-acute COVID-19 presentations and healthcare use in Australian general practice and comparisons to those with acute COVID-19 and upper respiratory tract infection

Background Post-acute COVID-19 syndrome (long COVID) is recognised internationally as a significant public health issue. Despite a large international literature on these conditions, there are still many gaps in understanding key aspects of their epidemiology and health system impact. This study examined patient characteristics, common symptoms, and healthcare utilisation associated with post-acute COVID-19 syndrome and compared this to acute COVID-19 and other upper respiratory tract infections (URTI) presenting to primary care. Methods We used MedicineInsight, a national general practice database, to identify adults diagnosed with post-acute COVID syndrome, acute COVID-19, or URTI between January and July 2022. Patients were required to be regular attenders with at least two GP visits in the previous two years. Sociodemographic and clinical characteristics were described, and multilevel Poisson regression was used for comparisons between groups. Symptoms, prescriptions, pathology, and imaging requests were examined for the 12 weeks before and after diagnosis. Results Among 102,907 patients, 701 were diagnosed with post-acute COVID syndrome, 74,486 with acute COVID-19, and 27,720 with URTI. Compared with acute COVID-19, individuals with post-acute COVID were more often female (RR 1.17 (95% CI:1.01–1.36)), aged 35–64 years and had higher rates of chronic respiratory disease and depression/anxiety. Compared with those with URTI, they were older, more often female (RR 1.22 (95% CI:1.05–1.42)), and less likely to smoke. Following diagnosis, patients with post-acute COVID experienced marked increases in fatigue (RR 3.37(95% CI:2.21, 5.14)), cough (RR 3.67(95% CI:2.19, 6.13)), and chest pain (RR 2.50(95% CI:1.28, 4.87)). Pathology requests doubled or tripled, while imaging increased sharply, including a six-fold rise in chest X-rays, exceeding increases observed in comparator groups. Conclusions Post-acute COVID syndrome in Australian general practice is most common among middle-aged women and those with respiratory or mental health comorbidities. Diagnosis is associated with substantially greater use of investigations than for acute COVID-19 or URTI, highlighting the diagnostic complexity and additional health system burden. Primary care data provides crucial insights into post-acute COVID-19 syndrome and can guide future health resource planning.