Investigating care outcomes and experiences of adults with Long COVID through patient- reported indicators (PROMs and PREMs) in Belgium

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Nevertheless, evidence regarding Long COVID patients’ perspectives, perceived health outcomes and care experiences in Belgium remains limited. Methods: OECD’s Patient-Reported Indicator Surveys (PaRIS) collected patient-reported outcome and experience measures (PROMS and PREMs) from individuals aged 45+ with chronic conditions. In Belgium, 4,687 primary care patients provided self-reported data between March 2023 and January 2024. This study explores the associated clinical and sociodemographic factors, care outcomes and experiences of adults with Long COVID in Belgium, by comparing respondents with and without Long COVID. Multivariate models were used to examine the clinical and sociodemographic determinants of Long COVID, and mixed-effects models were applied to compute the 10 key PROM and PREM indicators following the PaRIS10 methodology, accounting for the hierarchical structure of the data (patients nested within GP practices). Results: Overall, 50% (N=2,359) had a previous COVID-19 infection diagnosis, and over one in four (26%) of them reported Long COVID-related symptoms lasting 2 months or longer after COVID-19 infection (N=605, 12.9% overall prevalence). Higher risk of Long COVID was associated with being female, aged 45-54, lower educated, having multiple chronic conditions and higher BMI. Long COVID adults reported significant lower PROM scores for general health, wellbeing, physical and mental health compared to non-Long COVID respondents. Those with Long COVID symptoms lasting at least 1 year reported even poorer outcomes, particularly in general health, wellbeing and physical health. PREMs showed no significant differences between Long COVID and non-Long COVID respondents overall. However, trust in healthcare system and person-centred care was significant lower when Long COVID patients still had these long-term symptoms at survey time. Conclusions: In Belgium, adults with Long COVID report poorer health outcomes and less positive care experiences compared with those without Long COVID. These findings point to the substantial burden associated with Long COVID and to gaps in the current healthcare response to this emerging condition. Strengthening dedicated care pathways, improving coordination across services, and ensuring clear communication and support for patients will be essential to better address the needs of people living with Long COVID. Long COVID primary health care patient-reported indicators PROM PREM Belgium Figures Figure 1 Background Long COVID (also known as post-acute sequelae of COVID-19) is a multi-systemic condition comprising persistent symptoms (> 4 weeks) following the acute SARS-CoV-2 infection [ 1 ]. Long COVID is characterized by a wide range of symptoms that vary in nature and intensity, commonly including chronic fatigue, cognitive impairment (“brain fog”), respiratory difficulties, musculoskeletal pain, and cardiovascular issues [ 2 – 3 ]. Individuals living with Long COVID experience a significant reduction in quality of life, affecting physical, mental and social health, causing disability and reduced productivity [2;4–5]. Moreover, recovery from Long COVID remains uncertain for millions of patients worldwide [1;5]. Worldwide, people living with Long COVID have large healthcare needs, leading to increased healthcare utilization, additional healthcare and disability spending [2;4]. The impact of Long COVID extends beyond individual patients and challenges the capacity of healthcare systems. Services for Long COVID vary widely within and between healthcare systems. Furthermore, over the past years, Long COVID has raised growing concerns among healthcare professionals [1;6]. Primary care is at the forefront in caring for Long COVID patients and general practitioners (GPs) take up a key position as they are typically the first point of contact for patients experiencing persistent Long COVID symptoms [ 7 ]. As Long COVID symptoms may persistent for months, multidisciplinary approach to diagnosis and treatment is required [ 5 – 6 ]. A few countries, such as Belgium, France and Germany, have reported a national care trajectory for Long COVID with various level of implementation [ 8 ]. Unfortunately, due to the variability in Long COVID services, most people with Long COVID describe them as insufficient, and barriers to healthcare access, diversity in quality and equity of care have been identified [6;9–10]. In this regard, capturing Long COVID patients’ perspectives on perceived health outcomes and care experiences using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in primary care is an important approach [ 11 ]. Patient-reported indicators (PROMS, PREMS) are important for monitoring the quality of care and developing policies and practices in countries. Integrating patients’ perspectives in the approach to Long COVID enriches the understanding of care experiences and inform patient-centred care models. As information on Long COVID patients’ perceived health outcomes and care experiences is scarce for Belgium, this article aims to contribute to this knowledge gap. This study aims to investigate care outcomes and experiences of adults living with Long COVID in the general Belgian population, this through patient-reported indicators (PROMs and PREMs). Methods Study population and design OECD’s Patient-Reported Indicator Surveys (PaRIS) is a cross-sectional survey capturing patient-centred outcomes and experiences for individuals aged 45 years and older living with chronic conditions [ 12 ]. The PaRIS patient questionnaire (PaRIS-PQ) used in this study has been published and is publicly available on OECD’s website [ 13 ]. As part of this initiative, self-reported data was obtained from primary care patients from March 2023 to January 2024 in Belgium. A total of 4,687 patient survey responses (59.7% completed online, 40.3% on paper) were collected, which resulted in a 33.4% participation rate for Belgium. Information about GP and patient recruitment, participation and representativeness are available in the national report [ 14 ]. The core analysis of this study includes 2,359 participants (50.3%) who answered ‘yes’ to the question: ‘Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?’. When answering ‘yes’ on the former question, respondents received additional questions related to Long COVID. These COVID-related questions were based on those of the US Pulse household survey [ 15 ]. On the question ‘Did you have any symptoms lasting 2 months or longer that you did not have prior to having coronavirus or COVID-19?’ (Long term symptoms may include: tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as "brain fog", difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise’) , respondents could indicate the persistence of symptoms by choosing (1) Yes, symptoms lasted between 2–3 months, (2) Yes, symptoms lasted between 3–6 months, (3) Yes, symptoms lasted between 6 months – 1 year, (4) Yes, symptoms lasted at least 1 year, (5) No and (6) Not sure. When answering (1) to (4) on the Long COVID question, participants could indicate if they still have symptoms at survey time (‘Do you still have these long-term symptoms?’) by answering (1) Yes, (2) No and (3) Not sure. Measures This study investigates differences in care outcomes and healthcare experiences between adults living with and without Long COVID in Belgium. The primary dichotomous outcome variable was the Long COVID status, i.e. whether or not people self-reported Long COVID-related symptoms lasting 2 months or longer after COVID-19 infection. In addition, the following collected sociodemographic characteristics and risk factors were included as covariates in the analysis: age, gender, educational level, Body Mass Index (BMI) and number of chronic conditions. To assess Belgium’s healthcare performance through a patient-centred lens, the ten key indicators from the PaRIS10 Dashboard were used [ 12 ]. The PaRIS10 Dashboard includes five PROMs that capture essential aspects of health: physical health, mental health, social functioning, well-being and general health. In addition, five PREMs offer insight into critical interactions with healthcare services: confidence to self-manage, experienced care coordination, person-centred care, experienced quality of care and trust in health system. The national report provides detailed information on the construction of these ten key indicators [ 14 ]. Data management and informed consent Data were collected through both an online survey platform provided by Ipsos and paper questionnaires distributed by a third-party provider (TTP). Participants were encouraged, via the invitation letter, to complete the online survey. Those who preferred a paper version could request one by mail or by phone, or use the paper questionnaire included in the second reminder mailing. Informed consent was obtained from all participants included in the study. All methods were carried out in accordance with the declaration of Helsinki. Statistical analysis Descriptive statistics were conducted to summarize respondents’ characteristics and key outcome variables. Chi-square test (p < 0.05) was used to determine if there was a significant association between the categorical variables ‘Long COVID symptom persistence’ and ‘Long COVID-related symptoms at survey time’. Missing data for the primary outcome were minimal (N = 20, 0.8%) and missingness in covariates was low (< 11%). To optimize the representativeness of the results, the standardization variables (age and gender) in the models were rescaled to align with the 2023 Belgian population (aged 45+), using data retrieved from the Belgian national statistical office (STATBEL) [ 16 ]. Association between participant’s sociodemographic characteristics and risk factors, and the Long COVID status was assessed through a multivariate logistic regression model. Odds ratios (OR) and 95% confidence intervals (95% CI) were reported. A p-value < 0.05 was considered statistically significant. Multilevel models were conducted, taking into account the hierarchical structure of the data (GP practices – patients). Depending on the nature of the dependent variable, linear (continuous outcomes) or logistic (dichotomous outcomes) mixed-effects models were constructed, adjusted for age, gender and number of chronic conditions. These mixed-effects models were applied to compute the PaRIS10 indicators, in which values differing significantly (p < 0.05) from the reference group (participants without Long COVID) were indicated. Data management and analysis were performed in R version 4.4.1 and above. Results The sociodemographic and clinical characteristics of the respondents (adults aged 45+) are presented in Table 1 . Among the study participants, 51.6% were women, 56.0% were between 45–64 years old and 41.9% had a higher education. Of all respondents, 52.6% were overweight or obese, and one in five had no chronic condition. Table 1 Sociodemographic and clinical characteristics of study participants (N = 4,687) N % Socio-demographic characteristics Age categories 45–54 years old 1110 23.7 55–64 years old 1515 32.3 65–74 years old 1379 29.4 75 + years old 661 14.1 Missing 22 0.5 Gender Female 2420 51.6 Male 1940 41.4 Other 11 0.2 Prefer not to say 26 0.6 Missing 290 6.2 Level of education No education, primary or lower secondary education 1227 26.2 Higher secondary education 1305 27.8 Higher education 1965 41.9 Missing 190 4.1 Risk factors Body mass index (BMI) - WHO classification Underweight (< 18.5) 70 1.5 Normal (18.5–24.9) 1645 35.1 Overweight (25–29.9) 1654 35.3 Obesity (≥ 30.0) 813 17.3 Missing 505 10.8 BMI continuous (mean + SD) 26 4.6 Chronic disease Yes 3503 74.7 No 958 20.4 Missing 226 4.8 Clinical characteristics Previous COVID-19 diagnosis Yes 2359 50.3 No 2097 44.7 Not sure 50 1.1 Missing 181 3.9 If yes on previous COVID-19 diagnosis: Long COVID-related symptoms (n = 2,359) Yes, symptoms lasted between 2–3 months 320 13.6 Yes, symptoms lasted between 3–6 months 99 4.2 Yes, symptoms lasted between 6 months − 1 year 68 2.9 Yes, symptoms lasted at least 1 year 118 5.0 No 1588 67.3 Not sure 146 6.2 Missing 20 0.8 If yes on Long COVID-related symptoms: symptoms at survey time? (n = 605) Yes 165 27.3 No 352 58.2 Not sure 77 12.7 Missing 11 1.8 Half (50,3%; N = 2,359) of respondents reported having tested positive for or being diagnosed with COVID-19. Among those who had experienced COVID-19, over one in four (25.6%, N = 605) reported Long COVID-related symptoms beyond 2 months and 5.0% (N = 118) reported persistent symptoms beyond 12 months. Among participants who had experienced Long COVID-related symptoms (N = 605), about one in four (27.3%, N = 165) reported still experiencing symptoms at the time of the survey, with 58.8% of these reporting symptoms that had lasted at least 1 year (p = 3 months after initial COVID-19 infection) [ 17 ], Long COVID overall prevalence in primary care is 6.1% for Belgium. The logistic regression results show several important associations with Long COVID (Fig. 1 ). Being male was associated with a 37% lower odds of having Long COVID compared to females (OR = 0.63, p < .001). Age was also a significant factor, with older age groups showing progressively lower odds of Long COVID: 26% lower odds for 55–64 years old adults (OR = 0.74, p < .05), 42% lower odds for adults aged 65–74 years (OR = 0.58, p < .001), and 62% lower odds for 75+’ers (OR = 0.38, p < .001), compared to the youngest age group 45–54 years old. On the other hand, having more chronic conditions increased the risk: each additional chronic condition was associated with a 28% higher odds of Long COVID (OR = 1.28, p < .001). Compared to respondents with lower education, those with higher education having a 54% lower odds of Long COVID (OR = 0.46, p < .001). BMI was also linked to Long COVID, where each unit increase in BMI was associated with a 3% higher odds of Long COVID (OR = 1.03, p < .05). Table 2 presents the results for PaRIS10 indicators by Long COVID status and patient-reported persistence of symptoms. Adults with Long COVID reported significantly lower PROM scores for general health, wellbeing, physical and mental health compared to respondents without Long COVID. When symptom duration was taken into account, a strong physical health impact among all individuals with Long COVID was observed. Respondents mentioning short-term Long COVID symptoms (2–3 months) indicated a clear impact on general health, wellbeing, physical and mental health. Wellbeing was significant lower for those with symptoms lasting 6 months to 1 year, and individuals with symptoms persisting at least 1 year reported even poorer outcomes, particularly in general health, wellbeing and physical health. Moreover, when having these persistent symptoms at survey time, Long COVID adults self-rated all care outcomes significant lower, except for social functioning. Table 2 PaRIS10 indicators by Long COVID status (N = 2,193) Patient-reported outcome measures (PROMs) Patient-reported experience measures (PREMs) Long COVID (LC) General health (%) Well-being (/100) Physical health (16.2–67.7) Mental health (21.2–67.6) Social functioning (%) Experienced quality of care (%) Confidence to self-manage (%) Trust in healthcare system (%) Experienced coordination (/15) Person-centred care (/24) Positive Outcomes Good, very good, excellent ≥ 50 ≥ 42 ≥ 40 Good, very good, excellent Good, very good, excellent Confident, very confident Agree, strongly agree ≥ 7.5 ≥ 12.0 No Long COVID (n = 1,588) 81.7 64.5 48.3 47.9 90.6 96.8 69.5 73.7 9.27 18.3 Long COVID (n = 605) 71.3* 56.5*** 43.9*** 45.7*** 86.1 96.1 64 64.6 8.69 17.4 LC, symptoms lasted between 2–3 months (n = 320) 71.2* 56.8*** 43.9*** 45.2*** 85.5 95.4 63.5 64.2 8.76 17.7 LC, symptoms lasted between 3–6 months (n = 99) 80.1 58.4 45.7* 46.6 86.5 98.2 63.8 72.2 8.65 16.9 LC, symptoms lasted between 6 months – 1 year (n = 68) 68.6 57.2* 43.5*** 45.7 89.7 94.2 56.1 65 8.51 16.7 LC, symptoms lasted at least 1 year (n = 118) 65.7* 53.6*** 42.8*** 46.4 85.1 97.1 69.9 58.8 8.59 17.2 LC, long-term symptoms at survey time (n = 165) 60.2** 50.2*** 40.7*** 45.4*** 82.4 95.3 63 57.2*** 8.29 16.5*** Asterisks denote levels of statistical significance (* p < .05, ** p < .01, *** p < .001) relative to the reference category (No Long COVID). Results are adjusted for age, gender & number of chronic conditions, taking into account the hierarchical structure of the data. Data is weighted using STATBEL 2023 > = 45 years old. Self-reported experience measures (PREMs) showed no significant differences between Long COVID and non-Long COVID respondents overall (Table 2 ). However, trust in healthcare system and person-centred care was significant lower when adults with Long COVID still had these long-term symptoms at survey time. Discussion Key findings In this study, the primary care-based survey of PaRIS was used to provide estimates of the impact of Long COVID in the general population using primary care services. In Belgium, among primary care adults aged 45 years and older who have been infected with COVID-19, more than one in four (25.6%) reported persistent Long COVID-related symptoms beyond two months and for 5.0%, symptoms persisted beyond a year. Among 45 + Belgian adults, an overall Long Covid prevalence of 12.9% is estimated when symptoms persisted beyond two months, and 6.1% when persistence of symptoms is > = 3 months after the initial COVID-19 infection. These results are in line with other Belgian population sources. A survey among the general Belgian population (not focusing on individuals in contact with healthcare) estimated the prevalence of Long COVID among people aged 15 years and older on 4.2% when symptoms persisted at least 3 months [ 18 ]. Based on data from 16 OECD countries collected through the PaRIS survey, Long COVID prevalence (persistent symptoms > = 3 months) is estimated at 7.2% of the primary care population aged 45 years and older, with Belgium presenting comparable estimates to our surrounding countries (France, Netherlands, Germany, etc.) [ 8 ]. This study shows that adults with living Long COVID were more likely to be female, aged 45–54 years old and with a lower education level, echoing prior studies [ 19 – 20 ]. Higher risk of Long COVID was also associated with having multiple chronic conditions and a higher BMI, confirming other studies [ 21 – 22 ]. Through patient-reported indicators, care outcomes and experiences of adults with Long COVID in Belgium could be investigated. In this study, substantial differences in self-reported care outcomes were found between Long COVID and non-Long COVID respondents. Adults living with Long COVID reported poorer health outcomes for general health, wellbeing, physical and mental health. These results are in line with the study of Smith et al. [ 23 ] who reported a significant decline in health-related quality of life three months after SARS-CoV-2 infection among adults with Long COVID. Brus et al. [ 24 ] found that respondents 3–6 months post-acute infection had the worst health outcomes, with the lowest health-related quality of life, the highest fatigue level and highest proportion with a likely depressive disorder. The study of Scott et al. [ 25 ] confirmed this in a longitudinal study over two years by concluding that participants with Long COVID exhibited the worst health-related quality of life and mental well-being compared to non-Long COVID groups. The physical health impact of Long COVID for adults has been confirmed in various studies [23;26–28]. By taking into account symptoms’ persistence reported by people living with Long COVID, evolution in daily life burden is also explored in this study. These results on persistence of symptoms revealed that people perceived a strong overall health impact during the onset of Long COVID symptoms (first 2–3 months) and when symptoms lasted a year or longer. The study by Tran et al. [ 29 ] observed a U-shaped trend in the development of the perception of Long COVID impact on patient’s lives. Tran et al. found an aggravation six months after onset and theorized that this exacerbation relates to patients’ realization that persisting symptoms might be chronic rather than temporary. This is in line with the evolution in worsening of health outcomes found in this study where poorer outcomes in general health, wellbeing and physical health were reported when symptoms persisted at least one year. Adults with Long COVID symptoms at the time of the survey expressed lower trust in the healthcare system and reduced scores on person-centred care compared to non-Long COVID respondents. These results align with the study of Brus et al. [ 9 ] who encountered help-seeking barriers, issues in availability of care and financial barriers among people with Long COVID. Former studies also confirmed that people feel that Long COVID care doesn’t align with their patient needs and preferences, and many patients still face neglect, stigma and inadequate support [10;30–32]. This is also the case in Belgium where patients with Long COVID report unmet needs among others in care delivery, support, access to inclusion in the Long COVID care trajectory [ 33 – 34 ]. Moreover, as the majority of our study respondents were at survey time confronted with severe Long COVID symptoms (i.e. persistent symptoms for at least 1 year), these adults had higher care needs and service use, encountered higher care barriers and major health and life disruptions, including absenteeism from work or school [ 35 ]. Over the past pandemic years, Long COVID patients are not the only one reporting challenges navigating healthcare. Healthcare professionals also echo the need for a clear case definition, specific clinical guidelines, diagnostic tools and interdisciplinary support for Long COVID management [2;6;36]. The need for coordinated and integrated primary and secondary care for Long COVID, also recognized among Belgian GPs [ 37 ] may explain these lower scores in our study. Strengths and limitations Strengths of this study are OECD’s design of the PaRIS study, the use of standardised validated measures (PROMS and PREMS) and focus on ten study key indicators (the PaRIS10). This study has a population-based approach as the PaRIS survey concentrates exclusively on primary care users. Moreover, patient-reported indicators were collected on numerous adults with self-reported Long COVID (N > 600) in Belgium. This study has several limitations. The main limitation is the selection bias due to the design of the study. Adults with chronic conditions were overrepresented in our sample which limits generalizability. Moreover, Long COVID status was self-reported and measured as patient-reported persistence of symptoms, without confirmation based on medical records or diagnosis. Adults who recovered quickly or did not self-identify as having Long COVID may be missed in this study. Conclusion This study provides a deeper understanding of care outcomes and experiences of adults with Long COVID in Belgium, this through the collection of PROMS and PREMS among people aged 45 + consulting primary healthcare. This study found that adults living with Long COVID report poorer health outcomes and less positive care experiences compared to those without Long COVID, especially when symptoms persisted beyond one year. These results suggest shortcomings in the current Belgian response to Long COVID, including limited structured care pathways, variability in access to coordinated and multidisciplinary services, and insufficient support for patients with persistent symptoms. Capturing healthcare through the eyes of people suffering from Long COVID enrich our understanding of care experiences and inform patient-centred care models and health policy. Through the establishment of care pathways, interdisciplinary collaboration and coordinated management can further be expanded for Long COVID patients. Adequate training and support for healthcare professionals in primary and secondary care, and monitoring integrated care pathways for the long-term management of Long COVID can improve the experience of healthcare for adults with Long COVID in Belgium. Declarations Ethics approval and consent to participate The study has been approved by the ethics committee of Erasmus Hospital Brussels (EC reference number: P2021/385/B4062021000203). Informed consent was obtained from all participants included in the study. All methods were carried out in accordance with the declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Funding from the National Institute for Health and Disability Insurance (INAMI/RIZIV) of Belgium. Author contributions SM, RE and DA designed the study. RE and DA collected the data. SM and RE performed the analysis and interpretation of the data. SM drafted the manuscript and RE, PS, NS, SB, RD and DA critically revised the manuscript. All authors approved the final version of the manuscript. Acknowledgements The authors would like to thank everyone in Belgium who participated in the PaRIS study. References Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023 Mar;21(3):133–46. 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BMJ Open 2025;15:e094487. doi:10.1136/bmjopen-2024-094487 Turk F, Sweetman J, Chew-Graham CA, Gabbay M, Shepherd J, van der Feltz-Cornelis C; STIMULATE-ICP Consortium. Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study. Health Expect. 2024 Apr;27(2):e14008. doi: 10.1111/hex.14008. RIZIV-INAMI. Evaluatie van het gebruik van het zorgtraject long-COVID – PPT Colloque Covid Long 29 Septembre 2023. 2023. Available from: https://www.inami.fgov.be/SiteCollectionDocuments/evaluation_long_covid_belgium.pdf Jamoulle, M. (Éd.) et le Réseau de Recherche Long COVID. Long COVID, maladie invisible. 2025. Réseau de Recherche Long COVID, Charleroi, Belgique. 140p. [ORBi – Université de Liège]. Available from: https ://orbi.uliege.be/handle/2268/335502 Moreels S, Smith P, Charafeddine R, Castanares-Zapatero D, Van Cauteren D, Speybroeck N. Identifying Long Covid phenotypes and their association with personal characteristics, healthcare use, and daily life burden: a population-based study in Belgium. Scientific Reports , forthcoming Gomez-Bravo, R., León-Herrera, S., Guisado-Clavero, M. et al. Towards consensus: The need for standardised definitions in Long (post) COVID care in 34 European countries. European Journal of General Practice. 2025, 31(1). https://doi.org/10.1080/13814788.2025.2535618 Moreels S, Bensemmane S, De Schreye R, Cuschieri S. Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners’ knowledge, perception and experience in Belgium and Malta. BMC Prim Care. 2024 Oct 21;25(1):375. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":9174,"visible":true,"origin":"","legend":"\u003cp\u003eAssociationbetween clinical and sociodemographic characteristics and Long COVID among study participants (N=2,007)\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8346443/v1/4bb81258c8fef7bf0f97f5ae.png"},{"id":99323810,"identity":"37f790e4-2c9f-481d-88d4-503b8972265b","added_by":"auto","created_at":"2025-12-31 16:46:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1022578,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8346443/v1/83a1f34a-238d-4c7d-b8e9-4aa3492fa286.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Investigating care outcomes and experiences of adults with Long COVID through patient- reported indicators (PROMs and PREMs) in Belgium","fulltext":[{"header":"Background","content":"\u003cp\u003eLong COVID (also known as post-acute sequelae of COVID-19) is a multi-systemic condition comprising persistent symptoms (\u0026gt;\u0026thinsp;4 weeks) following the acute SARS-CoV-2 infection [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Long COVID is characterized by a wide range of symptoms that vary in nature and intensity, commonly including chronic fatigue, cognitive impairment (\u0026ldquo;brain fog\u0026rdquo;), respiratory difficulties, musculoskeletal pain, and cardiovascular issues [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Individuals living with Long COVID experience a significant reduction in quality of life, affecting physical, mental and social health, causing disability and reduced productivity [2;4\u0026ndash;5]. Moreover, recovery from Long COVID remains uncertain for millions of patients worldwide [1;5].\u003c/p\u003e \u003cp\u003eWorldwide, people living with Long COVID have large healthcare needs, leading to increased healthcare utilization, additional healthcare and disability spending [2;4]. The impact of Long COVID extends beyond individual patients and challenges the capacity of healthcare systems. Services for Long COVID vary widely within and between healthcare systems. Furthermore, over the past years, Long COVID has raised growing concerns among healthcare professionals [1;6]. Primary care is at the forefront in caring for Long COVID patients and general practitioners (GPs) take up a key position as they are typically the first point of contact for patients experiencing persistent Long COVID symptoms [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. As Long COVID symptoms may persistent for months, multidisciplinary approach to diagnosis and treatment is required [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A few countries, such as Belgium, France and Germany, have reported a national care trajectory for Long COVID with various level of implementation [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Unfortunately, due to the variability in Long COVID services, most people with Long COVID describe them as insufficient, and barriers to healthcare access, diversity in quality and equity of care have been identified [6;9\u0026ndash;10].\u003c/p\u003e \u003cp\u003eIn this regard, capturing Long COVID patients\u0026rsquo; perspectives on perceived health outcomes and care experiences using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in primary care is an important approach [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Patient-reported indicators (PROMS, PREMS) are important for monitoring the quality of care and developing policies and practices in countries. Integrating patients\u0026rsquo; perspectives in the approach to Long COVID enriches the understanding of care experiences and inform patient-centred care models. As information on Long COVID patients\u0026rsquo; perceived health outcomes and care experiences is scarce for Belgium, this article aims to contribute to this knowledge gap.\u003c/p\u003e \u003cp\u003eThis study aims to investigate care outcomes and experiences of adults living with Long COVID in the general Belgian population, this through patient-reported indicators (PROMs and PREMs).\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population and design\u003c/h2\u003e \u003cp\u003eOECD\u0026rsquo;s Patient-Reported Indicator Surveys (PaRIS) is a cross-sectional survey capturing patient-centred outcomes and experiences for individuals aged 45 years and older living with chronic conditions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The PaRIS patient questionnaire (PaRIS-PQ) used in this study has been published and is publicly available on OECD\u0026rsquo;s website [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. As part of this initiative, self-reported data was obtained from primary care patients from March 2023 to January 2024 in Belgium. A total of 4,687 patient survey responses (59.7% completed online, 40.3% on paper) were collected, which resulted in a 33.4% participation rate for Belgium. Information about GP and patient recruitment, participation and representativeness are available in the national report [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe core analysis of this study includes 2,359 participants (50.3%) who answered \u0026lsquo;yes\u0026rsquo; to the question: \u0026lsquo;Have you ever tested positive for COVID-19 (using a rapid point-of-care test, self-test, or laboratory test) or been told by a doctor or other health care provider that you have or had COVID-19?\u0026rsquo;. When answering \u0026lsquo;yes\u0026rsquo; on the former question, respondents received additional questions related to Long COVID. These COVID-related questions were based on those of the US Pulse household survey [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. On the question \u0026lsquo;Did you have any symptoms lasting 2 months or longer that you did not have prior to having coronavirus or COVID-19?\u0026rsquo; \u003cem\u003e(Long term symptoms may include: tiredness or fatigue, difficulty thinking, concentrating, forgetfulness, or memory problems (sometimes referred to as \"brain fog\", difficulty breathing or shortness of breath, joint or muscle pain, fast-beating or pounding heart (also known as heart palpitations), chest pain, dizziness on standing, menstrual changes, changes to taste/smell, or inability to exercise\u0026rsquo;)\u003c/em\u003e, respondents could indicate the persistence of symptoms by choosing (1) Yes, symptoms lasted between 2\u0026ndash;3 months, (2) Yes, symptoms lasted between 3\u0026ndash;6 months, (3) Yes, symptoms lasted between 6 months \u0026ndash; 1 year, (4) Yes, symptoms lasted at least 1 year, (5) No and (6) Not sure. When answering (1) to (4) on the Long COVID question, participants could indicate if they still have symptoms at survey time (\u0026lsquo;Do you still have these long-term symptoms?\u0026rsquo;) by answering (1) Yes, (2) No and (3) Not sure.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cp\u003eThis study investigates differences in care outcomes and healthcare experiences between adults living with and without Long COVID in Belgium. The primary dichotomous outcome variable was the Long COVID status, i.e. whether or not people self-reported Long COVID-related symptoms lasting 2 months or longer after COVID-19 infection.\u003c/p\u003e \u003cp\u003eIn addition, the following collected sociodemographic characteristics and risk factors were included as covariates in the analysis: age, gender, educational level, Body Mass Index (BMI) and number of chronic conditions.\u003c/p\u003e \u003cp\u003eTo assess Belgium\u0026rsquo;s healthcare performance through a patient-centred lens, the ten key indicators from the PaRIS10 Dashboard were used [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The PaRIS10 Dashboard includes five PROMs that capture essential aspects of health: physical health, mental health, social functioning, well-being and general health. In addition, five PREMs offer insight into critical interactions with healthcare services: confidence to self-manage, experienced care coordination, person-centred care, experienced quality of care and trust in health system. The national report provides detailed information on the construction of these ten key indicators [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eData management and informed consent\u003c/h3\u003e\n\u003cp\u003eData were collected through both an online survey platform provided by Ipsos and paper questionnaires distributed by a third-party provider (TTP). Participants were encouraged, via the invitation letter, to complete the online survey. Those who preferred a paper version could request one by mail or by phone, or use the paper questionnaire included in the second reminder mailing. Informed consent was obtained from all participants included in the study. All methods were carried out in accordance with the declaration of Helsinki.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDescriptive statistics were conducted to summarize respondents\u0026rsquo; characteristics and key outcome variables. Chi-square test (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) was used to determine if there was a significant association between the categorical variables \u0026lsquo;Long COVID symptom persistence\u0026rsquo; and \u0026lsquo;Long COVID-related symptoms at survey time\u0026rsquo;. Missing data for the primary outcome were minimal (N\u0026thinsp;=\u0026thinsp;20, 0.8%) and missingness in covariates was low (\u0026lt;\u0026thinsp;11%).\u003c/p\u003e \u003cp\u003eTo optimize the representativeness of the results, the standardization variables (age and gender) in the models were rescaled to align with the 2023 Belgian population (aged 45+), using data retrieved from the Belgian national statistical office (STATBEL) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAssociation between participant\u0026rsquo;s sociodemographic characteristics and risk factors, and the Long COVID status was assessed through a multivariate logistic regression model. Odds ratios (OR) and 95% confidence intervals (95% CI) were reported. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003cp\u003eMultilevel models were conducted, taking into account the hierarchical structure of the data (GP practices \u0026ndash; patients). Depending on the nature of the dependent variable, linear (continuous outcomes) or logistic (dichotomous outcomes) mixed-effects models were constructed, adjusted for age, gender and number of chronic conditions. These mixed-effects models were applied to compute the PaRIS10 indicators, in which values differing significantly (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05) from the reference group (participants without Long COVID) were indicated.\u003c/p\u003e \u003cp\u003eData management and analysis were performed in R version 4.4.1 and above.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe sociodemographic and clinical characteristics of the respondents (adults aged 45+) are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. Among the study participants, 51.6% were women, 56.0% were between 45\u0026ndash;64 years old and 41.9% had a higher education. Of all respondents, 52.6% were overweight or obese, and one in five had no chronic condition.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSociodemographic and clinical characteristics of study participants (N\u0026thinsp;=\u0026thinsp;4,687)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cem\u003eSocio-demographic characteristics\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eAge categories\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45\u0026ndash;54 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55\u0026ndash;64 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u0026ndash;74 years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e75\u0026thinsp;+\u0026thinsp;years old\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2420\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1940\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrefer not to say\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eLevel of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo education, primary or lower secondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher secondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1965\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eRisk factors\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eBody mass index (BMI) - WHO classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnderweight (\u0026lt;\u0026thinsp;18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNormal (18.5\u0026ndash;24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1645\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOverweight (25\u0026ndash;29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1654\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eObesity (\u0026ge;\u0026thinsp;30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e813\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e505\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eBMI continuous (mean\u0026thinsp;+\u0026thinsp;SD)\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u003cem\u003e26\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003e4.6\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eChronic disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e958\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical characteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePrevious COVID-19 diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2359\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2097\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIf yes on previous COVID-19 diagnosis: Long COVID-related symptoms (n\u0026thinsp;=\u0026thinsp;2,359)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, symptoms lasted between 2\u0026ndash;3 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, symptoms lasted between 3\u0026ndash;6 months\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, symptoms lasted between 6 months \u0026minus;\u0026thinsp;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes, symptoms lasted at least 1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eIf yes on Long COVID-related symptoms: symptoms at survey time? (n\u0026thinsp;=\u0026thinsp;605)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNot sure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eHalf (50,3%; N\u0026thinsp;=\u0026thinsp;2,359) of respondents reported having tested positive for or being diagnosed with COVID-19. Among those who had experienced COVID-19, over one in four (25.6%, N\u0026thinsp;=\u0026thinsp;605) reported Long COVID-related symptoms beyond 2 months and 5.0% (N\u0026thinsp;=\u0026thinsp;118) reported persistent symptoms beyond 12 months. Among participants who had experienced Long COVID-related symptoms (N\u0026thinsp;=\u0026thinsp;605), about one in four (27.3%, N\u0026thinsp;=\u0026thinsp;165) reported still experiencing symptoms at the time of the survey, with 58.8% of these reporting symptoms that had lasted at least 1 year (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eFor Belgium, an overall Long COVID prevalence of 12.9% among primary care 45\u0026thinsp;+\u0026thinsp;adults is estimated. When applying the stricter WHO case definition (i.e. persistence of symptoms\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3 months after initial COVID-19 infection) [\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e], Long COVID overall prevalence in primary care is 6.1% for Belgium.\u003c/p\u003e\n\u003cp\u003eThe logistic regression results show several important associations with Long COVID (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). Being male was associated with a 37% lower odds of having Long COVID compared to females (OR\u0026thinsp;=\u0026thinsp;0.63, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Age was also a significant factor, with older age groups showing progressively lower odds of Long COVID: 26% lower odds for 55\u0026ndash;64 years old adults (OR\u0026thinsp;=\u0026thinsp;0.74, p\u0026thinsp;\u0026lt;\u0026thinsp;.05), 42% lower odds for adults aged 65\u0026ndash;74 years (OR\u0026thinsp;=\u0026thinsp;0.58, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and 62% lower odds for 75+\u0026rsquo;ers (OR\u0026thinsp;=\u0026thinsp;0.38, p\u0026thinsp;\u0026lt;\u0026thinsp;.001), compared to the youngest age group 45\u0026ndash;54 years old. On the other hand, having more chronic conditions increased the risk: each additional chronic condition was associated with a 28% higher odds of Long COVID (OR\u0026thinsp;=\u0026thinsp;1.28, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Compared to respondents with lower education, those with higher education having a 54% lower odds of Long COVID (OR\u0026thinsp;=\u0026thinsp;0.46, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). BMI was also linked to Long COVID, where each unit increase in BMI was associated with a 3% higher odds of Long COVID (OR\u0026thinsp;=\u0026thinsp;1.03, p\u0026thinsp;\u0026lt;\u0026thinsp;.05).\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the results for PaRIS10 indicators by Long COVID status and patient-reported persistence of symptoms. Adults with Long COVID reported significantly lower PROM scores for general health, wellbeing, physical and mental health compared to respondents without Long COVID. When symptom duration was taken into account, a strong physical health impact among all individuals with Long COVID was observed. Respondents mentioning short-term Long COVID symptoms (2\u0026ndash;3 months) indicated a clear impact on general health, wellbeing, physical and mental health. Wellbeing was significant lower for those with symptoms lasting 6 months to 1 year, and individuals with symptoms persisting at least 1 year reported even poorer outcomes, particularly in general health, wellbeing and physical health. Moreover, when having these persistent symptoms at survey time, Long COVID adults self-rated all care outcomes significant lower, except for social functioning.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003ePaRIS10 indicators by Long COVID status (N\u0026thinsp;=\u0026thinsp;2,193)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"11\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ePatient-reported outcome measures (PROMs)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"5\"\u003e\n \u003cp\u003ePatient-reported experience measures (PREMs)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLong COVID (LC)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGeneral health (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWell-being (/100)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePhysical health (16.2\u0026ndash;67.7)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMental health (21.2\u0026ndash;67.6)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSocial functioning (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperienced quality of care (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eConfidence to self-manage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTrust in healthcare system (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eExperienced coordination (/15)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePerson-centred care (/24)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePositive Outcomes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood, very good, excellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood, very good, excellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood, very good, excellent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConfident, very confident\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAgree, strongly agree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo Long COVID (n\u0026thinsp;=\u0026thinsp;1,588)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e48.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e90.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e18.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLong COVID (n\u0026thinsp;=\u0026thinsp;605)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.3*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.5***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.9***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.7***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLC, symptoms lasted between 2\u0026ndash;3 months (n\u0026thinsp;=\u0026thinsp;320)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71.2*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.8***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.9***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.2***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLC, symptoms lasted between 3\u0026ndash;6 months (n\u0026thinsp;=\u0026thinsp;99)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e80.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.7*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLC, symptoms lasted between 6 months \u0026ndash; 1 year (n\u0026thinsp;=\u0026thinsp;68)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.2*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.5***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e94.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLC, symptoms lasted at least 1 year (n\u0026thinsp;=\u0026thinsp;118)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.7*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53.6***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.8***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLC, long-term symptoms at survey time (n\u0026thinsp;=\u0026thinsp;165)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.2**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50.2***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.7***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45.4***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57.2***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e8.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e16.5***\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003eAsterisks denote levels of statistical significance (* p\u0026thinsp;\u0026lt;\u0026thinsp;.05, ** p\u0026thinsp;\u0026lt;\u0026thinsp;.01, *** p\u0026thinsp;\u0026lt;\u0026thinsp;.001) relative to the reference category (No Long COVID).\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"11\"\u003eResults are adjusted for age, gender \u0026amp; number of chronic conditions, taking into account the hierarchical structure of the data. Data is weighted using STATBEL 2023\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;45 years old.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSelf-reported experience measures (PREMs) showed no significant differences between Long COVID and non-Long COVID respondents overall (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). However, trust in healthcare system and person-centred care was significant lower when adults with Long COVID still had these long-term symptoms at survey time.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eKey findings\u003c/h2\u003e \u003cp\u003eIn this study, the primary care-based survey of PaRIS was used to provide estimates of the impact of Long COVID in the general population using primary care services. In Belgium, among primary care adults aged 45 years and older who have been infected with COVID-19, more than one in four (25.6%) reported persistent Long COVID-related symptoms beyond two months and for 5.0%, symptoms persisted beyond a year. Among 45\u0026thinsp;+\u0026thinsp;Belgian adults, an overall Long Covid prevalence of 12.9% is estimated when symptoms persisted beyond two months, and 6.1% when persistence of symptoms is \u0026gt;\u0026thinsp;=\u0026thinsp;3 months after the initial COVID-19 infection. These results are in line with other Belgian population sources. A survey among the general Belgian population (not focusing on individuals in contact with healthcare) estimated the prevalence of Long COVID among people aged 15 years and older on 4.2% when symptoms persisted at least 3 months [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Based on data from 16 OECD countries collected through the PaRIS survey, Long COVID prevalence (persistent symptoms\u0026thinsp;\u0026gt;\u0026thinsp;=\u0026thinsp;3 months) is estimated at 7.2% of the primary care population aged 45 years and older, with Belgium presenting comparable estimates to our surrounding countries (France, Netherlands, Germany, etc.) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study shows that adults with living Long COVID were more likely to be female, aged 45\u0026ndash;54 years old and with a lower education level, echoing prior studies [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Higher risk of Long COVID was also associated with having multiple chronic conditions and a higher BMI, confirming other studies [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThrough patient-reported indicators, care outcomes and experiences of adults with Long COVID in Belgium could be investigated. In this study, substantial differences in self-reported care outcomes were found between Long COVID and non-Long COVID respondents. Adults living with Long COVID reported poorer health outcomes for general health, wellbeing, physical and mental health. These results are in line with the study of Smith et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] who reported a significant decline in health-related quality of life three months after SARS-CoV-2 infection among adults with Long COVID. Brus et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] found that respondents 3\u0026ndash;6 months post-acute infection had the worst health outcomes, with the lowest health-related quality of life, the highest fatigue level and highest proportion with a likely depressive disorder. The study of Scott et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] confirmed this in a longitudinal study over two years by concluding that participants with Long COVID exhibited the worst health-related quality of life and mental well-being compared to non-Long COVID groups. The physical health impact of Long COVID for adults has been confirmed in various studies [23;26\u0026ndash;28].\u003c/p\u003e \u003cp\u003eBy taking into account symptoms\u0026rsquo; persistence reported by people living with Long COVID, evolution in daily life burden is also explored in this study. These results on persistence of symptoms revealed that people perceived a strong overall health impact during the onset of Long COVID symptoms (first 2\u0026ndash;3 months) and when symptoms lasted a year or longer. The study by Tran et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] observed a U-shaped trend in the development of the perception of Long COVID impact on patient\u0026rsquo;s lives. Tran et al. found an aggravation six months after onset and theorized that this exacerbation relates to patients\u0026rsquo; realization that persisting symptoms might be chronic rather than temporary. This is in line with the evolution in worsening of health outcomes found in this study where poorer outcomes in general health, wellbeing and physical health were reported when symptoms persisted at least one year.\u003c/p\u003e \u003cp\u003eAdults with Long COVID symptoms at the time of the survey expressed lower trust in the healthcare system and reduced scores on person-centred care compared to non-Long COVID respondents. These results align with the study of Brus et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] who encountered help-seeking barriers, issues in availability of care and financial barriers among people with Long COVID. Former studies also confirmed that people feel that Long COVID care doesn\u0026rsquo;t align with their patient needs and preferences, and many patients still face neglect, stigma and inadequate support [10;30\u0026ndash;32]. This is also the case in Belgium where patients with Long COVID report unmet needs among others in care delivery, support, access to inclusion in the Long COVID care trajectory [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Moreover, as the majority of our study respondents were at survey time confronted with severe Long COVID symptoms (i.e. persistent symptoms for at least 1 year), these adults had higher care needs and service use, encountered higher care barriers and major health and life disruptions, including absenteeism from work or school [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Over the past pandemic years, Long COVID patients are not the only one reporting challenges navigating healthcare. Healthcare professionals also echo the need for a clear case definition, specific clinical guidelines, diagnostic tools and interdisciplinary support for Long COVID management [2;6;36]. The need for coordinated and integrated primary and secondary care for Long COVID, also recognized among Belgian GPs [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] may explain these lower scores in our study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStrengths and limitations\u003c/h3\u003e\n\u003cp\u003eStrengths of this study are OECD\u0026rsquo;s design of the PaRIS study, the use of standardised validated measures (PROMS and PREMS) and focus on ten study key indicators (the PaRIS10). This study has a population-based approach as the PaRIS survey concentrates exclusively on primary care users. Moreover, patient-reported indicators were collected on numerous adults with self-reported Long COVID (N\u0026thinsp;\u0026gt;\u0026thinsp;600) in Belgium.\u003c/p\u003e \u003cp\u003eThis study has several limitations. The main limitation is the selection bias due to the design of the study. Adults with chronic conditions were overrepresented in our sample which limits generalizability. Moreover, Long COVID status was self-reported and measured as patient-reported persistence of symptoms, without confirmation based on medical records or diagnosis. Adults who recovered quickly or did not self-identify as having Long COVID may be missed in this study.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides a deeper understanding of care outcomes and experiences of adults with Long COVID in Belgium, this through the collection of PROMS and PREMS among people aged 45\u0026thinsp;+\u0026thinsp;consulting primary healthcare. This study found that adults living with Long COVID report poorer health outcomes and less positive care experiences compared to those without Long COVID, especially when symptoms persisted beyond one year. These results suggest shortcomings in the current Belgian response to Long COVID, including limited structured care pathways, variability in access to coordinated and multidisciplinary services, and insufficient support for patients with persistent symptoms.\u003c/p\u003e \u003cp\u003eCapturing healthcare through the eyes of people suffering from Long COVID enrich our understanding of care experiences and inform patient-centred care models and health policy. Through the establishment of care pathways, interdisciplinary collaboration and coordinated management can further be expanded for Long COVID patients. Adequate training and support for healthcare professionals in primary and secondary care, and monitoring integrated care pathways for the long-term management of Long COVID can improve the experience of healthcare for adults with Long COVID in Belgium.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study has been approved by the ethics committee of Erasmus Hospital Brussels (EC reference number: P2021/385/B4062021000203). Informed consent was obtained from all participants included in the study. All methods were carried out in accordance with the declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding from the National Institute for Health and Disability Insurance (INAMI/RIZIV) of Belgium.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM, RE and DA designed the study. RE and DA collected the data. SM and RE performed the analysis and interpretation of the data. SM drafted the manuscript and RE, PS, NS, SB, RD and DA critically revised the manuscript. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank everyone in Belgium who participated in the PaRIS study.\u003c/p\u003e"},{"header":"References ","content":"\u003col\u003e\n\u003cli\u003eDavis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nat Rev Microbiol. 2023 Mar;21(3):133\u0026ndash;46.\u003c/li\u003e\n\u003cli\u003eAl-Aly Z, Davis H, McCorkell L, Soares L, Wulf-Hanson S, Iwasaki A, et al. Long COVID science, research and policy. Nat Med. 2024 Aug;30(8):2148\u0026ndash;64.\u003c/li\u003e\n\u003cli\u003eNatarajan A, Shetty A, Delanerolle G, Zeng Y, Zhang Y, Raymont V, et al. A systematic review and meta-analysis of long COVID symptoms. Syst Rev. 2023 May 27;12(1):88.\u003c/li\u003e\n\u003cli\u003eEuropean Commission: Directorate-General for Economic and Financial Affairs, Calvo Ramos, S., Maldonado, J. E., Vandeplas, A. and V\u0026aacute;nyol\u0026oacute;s, I. Long COVID \u0026ndash; A tentative assessment of its impact on labour market participation \u0026amp; potential economic effects in the EU, Publications Office of the European Union, 2024. Available from: https://data.europa.eu/doi/10.2765/245526.\u003c/li\u003e\n\u003cli\u003eRathod N, Kumar S, Chavhan R, Acharya S, Rathod S. Navigating the Long Haul: A Comprehensive Review of Long-COVID Sequelae, Patient Impact, Pathogenesis, and Management. Cureus. 2024 May 13;16(5):e60176. doi: 10.7759/cureus.60176.\u003c/li\u003e\n\u003cli\u003eGreenhalgh T, Sivan M, Perlowski A, Nikolich JŽ. Long COVID: a clinical update. Lancet Lond Engl. 2024 Aug 17;404(10453):707\u0026ndash;24.\u003c/li\u003e\n\u003cli\u003eGreenhalgh T, Knight M, A\u0026rsquo;Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care. BMJ. 2020;370:m3026. https://doi. org/10.1136/bmj.m3026. \u003c/li\u003e\n\u003cli\u003eOECD. The prevalence and impact of Long COVID in the primary care population: Findings from the OECD PaRIS survey. 2025, OECD Publishing, Paris. Available from: https://doi.org/10.1787/119b0e8f-en.\u003c/li\u003e\n\u003cli\u003eBrus IM, Spronk I, Polinder S, Loohuis AGMO, Tieleman P, Heemskerk SCM, et al. Self-perceived barriers to healthcare access for patients with post COVID-19 condition. BMC Health Serv Res. 2024 Sep 6;24(1):1035.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Service delivery models for people with post COVID-19 conditions in selected European countries: summary report. Copenhagen: WHO Regional Office for Europe; 2024. Licence: CC BY-NC-SA 3.0 IGO. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2024-9389-49161-73359.\u003c/li\u003e\n\u003cli\u003eBaalmann AK, Blome C, Stoletzki N, Donhauser T, Apfelbacher C, Piontek K. Patient-reported outcome measures for post-COVID-19 condition: a systematic review of instruments and measurement properties. BMJ Open. 2024 Dec 20;14(12):e084202. doi: 10.1136/bmjopen-2024-084202.\u003c/li\u003e\n\u003cli\u003eOECD (2025). Does Healthcare Deliver?: Results from the Patient-Reported Indicator Surveys (PaRIS). OECD Publishing, Paris. Available from: https://doi.org/10.1787/c8af05a5-en.\u003c/li\u003e\n\u003cli\u003eOECD (2024). PaRIS (Patient Reported Indicator Surveys) \u0026ndash; PaRIS Patient Questionnaire (PaRIS-PQ) \u0026ndash; English version. OECD Publishing, Paris. Available from: https://www.oecd.org/content/dam/oecd/en/about/programmes/patient-reported-indicator-surveys/PaRIS%20patient%20questionnaire.pdf\u003c/li\u003e\n\u003cli\u003eAnnaert D, Ekelson R, Bensemmane S, Van Vyve A, De Schreye R. Patient-Reported Indicator Surveys (PaRIS): Insights from Belgium. Focused on people living with chronic conditions. Brussels, Belgium: Sciensano. 2025, June. Report number: D/2025.14.440/15.\u003c/li\u003e\n\u003cli\u003eUS Census Bureau. Household Pulse Survey: Measuring Emergent Social and Economic Matters Facing U.S. Households. Available from: https://www.census.gov/programs-surveys/household-pulse-survey.html\u003c/li\u003e\n\u003cli\u003eSTATBEL. Population data 2023. 2023. Available from: https://statbel.fgov.be/en/\u003c/li\u003e\n\u003cli\u003eWorld Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. WHO; 2021. Available from: https://iris.who.int/handle/10665/345824. License: CC BY-NC-SA 3.0 IGO.\u003c/li\u003e\n\u003cli\u003eSmith P, Hermans L, Janssens M. Gezondheidsenqu\u0026ecirc;te 2023-2024: COVID-19. Brussel, Belgi\u0026euml;: Sciensano; 2025. Rapportnummer: D/2025.14.440/38. Available from: www.gezondheidenquete.be\u003c/li\u003e\n\u003cli\u003eGerritzen I, Brus IM, Spronk I, Biere-Rafi S, Polinder S, Haagsma JA. Identification of post-COVID-19 condition phenotypes, and differences in health-related quality of life and healthcare use: a cluster analysis. Epidemiol Infect. 2023 Jan;151:e123.\u003c/li\u003e\n\u003cli\u003eNayani S, Castanares-Zapatero D, De Pauw R, et al. Classification of post COVID-19 condition symptoms: a longitudinal study in the Belgian population. BMJ Open 2023;13:e072726.\u003c/li\u003e\n\u003cli\u003eYang J, Tamberou C, Arnee E, Squara PA, Boukhlal A, Nguyen JL, et al. All-cause healthcare resource utilization and costs among community-managed adults with long-COVID in France, 2020-2023. J Med Econ. 2025 Dec;28(1):535\u0026ndash;43.\u003c/li\u003e\n\u003cli\u003evan Zon SKR, Ballering AV, Brouwer S, Rosmalen JGM; Lifelines Corona Research Initiative. Symptom profiles and their risk factors in patients with post-COVID-19 condition: a Dutch longitudinal cohort study. Eur J Public Health. 2023 Dec 9;33(6):1163-1170. doi: 10.1093/eurpub/ckad152.\u003c/li\u003e\n\u003cli\u003eSmith P, De Pauw R, Van Cauteren D, Demarest S, Drieskens S, Cornelissen L, et al. Post COVID-19 condition and health-related quality of life: a longitudinal cohort study in the Belgian adult population. BMC Public Health. 2023 Jul 27;23(1):1433.\u003c/li\u003e\n\u003cli\u003eBrus IM, Spronk I, Haagsma JA, de Groot A, Tieleman P, Biere-Rafi S, et al. The prolonged impact of COVID-19 on symptoms, health-related quality of life, fatigue and mental well-being: a cross-sectional study. Front Epidemiol. 2023 Jun 22; 3:1144707.\u003c/li\u003e\n\u003cli\u003eScott ES, Lubetkin EI, Janssen MF, Yfantopolous J, Bonsel GJ and Haagsma JA. Cross-sectional and longitudinal comparison of health-related quality of life and mental well-being between persons with and without post COVID-19 condition. Front. Epidemiol. 3:1144162. doi: 10.3389/fepid.2023.1144162\u003c/li\u003e\n\u003cli\u003eKosowan L, Sanchez-Ramirez DC, Katz A. Understanding symptoms suggestive of long COVID syndrome and healthcare use among community-based populations in Manitoba, Canada: an observational cross-sectional survey. BMJ Open. 2024 Jan 1;14(1):e075301.\u003c/li\u003e\n\u003cli\u003eNguyen, K.H.; Bao, Y.; Mortazavi, J.; Allen, J.D.; Chocano-Bedoya, P.O.; Corlin, L. Prevalence and Factors Associated with Long COVID Symptoms among U.S. Adults, 2022. Vaccines 2024, 12, 99. https://doi.org/10.3390/vaccines12010099\u003c/li\u003e\n\u003cli\u003eZiauddeen N, Gurdasani D, O\u0026rsquo;Hara ME, Hastie C, Roderick P, Yao G, et al. Characteristics and impact of Long Covid: Findings from an online survey. PLOS ONE. 2022 Mar 8;17(3):e0264331.\u003c/li\u003e\n\u003cli\u003eTran, VT., Porcher, R., Pane, I. et al. Course of post COVID-19 disease symptoms over time in the ComPaRe long COVID prospective e-cohort. Nat Commun 13, 1812 (2022). https://doi.org/10.1038/s41467-022-29513-z\u003c/li\u003e\n\u003cli\u003eLotankar Y, Cheshire A, Ridge D, et al. Intersectionality and Long Covid: Understanding the Lived Experiences of Ethnic Minority Groups in the United Kingdom. Health Expect 2025; 28:1. https://doi.org/10.1111/hex.70413.\u003c/li\u003e\n\u003cli\u003eNyaaba GN, Torensma M, Goldschmidt MI, et al. Experiences of stigma and access to care among long COVID patients: a qualitative study in a multi-ethnic population in the Netherlands. BMJ Open 2025;15:e094487. doi:10.1136/bmjopen-2024-094487\u003c/li\u003e\n\u003cli\u003eTurk F, Sweetman J, Chew-Graham CA, Gabbay M, Shepherd J, van der Feltz-Cornelis C; STIMULATE-ICP Consortium. Accessing care for Long Covid from the perspectives of patients and healthcare practitioners: A qualitative study. Health Expect. 2024 Apr;27(2):e14008. doi: 10.1111/hex.14008.\u003c/li\u003e\n\u003cli\u003eRIZIV-INAMI. Evaluatie van het gebruik van het zorgtraject long-COVID \u0026ndash; PPT Colloque Covid Long 29 Septembre 2023. 2023. Available from: https://www.inami.fgov.be/SiteCollectionDocuments/evaluation_long_covid_belgium.pdf\u003c/li\u003e\n\u003cli\u003eJamoulle, M. (\u0026Eacute;d.) et le R\u0026eacute;seau de Recherche Long COVID. Long COVID, maladie invisible. 2025. R\u0026eacute;seau de Recherche Long COVID, Charleroi, Belgique. 140p. [ORBi \u0026ndash; Universit\u0026eacute; de Li\u0026egrave;ge]. Available from: https ://orbi.uliege.be/handle/2268/335502\u003c/li\u003e\n\u003cli\u003eMoreels S, Smith P, Charafeddine R, Castanares-Zapatero D, Van Cauteren D, Speybroeck N. Identifying Long Covid phenotypes and their association with personal characteristics, healthcare use, and daily life burden: a population-based study in Belgium. \u003cem\u003eScientific Reports\u003c/em\u003e, forthcoming\u003c/li\u003e\n\u003cli\u003eGomez-Bravo, R., Le\u0026oacute;n-Herrera, S., Guisado-Clavero, M. et al. Towards consensus: The need for standardised definitions in Long (post) COVID care in 34 European countries. European Journal of General Practice. 2025, 31(1). https://doi.org/10.1080/13814788.2025.2535618\u003c/li\u003e\n\u003cli\u003eMoreels S, Bensemmane S, De Schreye R, Cuschieri S. Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners\u0026rsquo; knowledge, perception and experience in Belgium and Malta. BMC Prim Care. 2024 Oct 21;25(1):375.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Long COVID, primary health care, patient-reported indicators, PROM, PREM, Belgium","lastPublishedDoi":"10.21203/rs.3.rs-8346443/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8346443/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLong COVID, with its multisystemic manifestations, poses a substantial burden on health systems. Nevertheless, evidence regarding Long COVID patients’ perspectives, perceived health outcomes and care experiences in Belgium remains limited.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOECD’s Patient-Reported Indicator Surveys (PaRIS) collected patient-reported outcome and experience measures (PROMS and PREMs) from individuals aged 45+ with chronic conditions. In Belgium, 4,687 primary care patients provided self-reported data between March 2023 and January 2024.\u003c/p\u003e\n\u003cp\u003eThis study explores the associated clinical and sociodemographic factors, care outcomes and experiences of adults with Long COVID in Belgium, by comparing respondents with and without Long COVID. Multivariate models were used to examine the clinical and sociodemographic determinants of Long COVID, and mixed-effects models were applied to compute the 10 key PROM and PREM indicators following the PaRIS10 methodology, accounting for the hierarchical structure of the data (patients nested within GP practices).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOverall, 50% (N=2,359) had a previous COVID-19 infection diagnosis, and over one in four (26%) of them reported Long COVID-related symptoms lasting 2 months or longer after COVID-19 infection (N=605, 12.9% overall prevalence).\u003c/p\u003e\n\u003cp\u003eHigher risk of Long COVID was associated with being female, aged 45-54, lower educated, having multiple chronic conditions and higher BMI.\u003c/p\u003e\n\u003cp\u003eLong COVID adults reported significant lower PROM scores for general health, wellbeing, physical and mental health compared to non-Long COVID respondents. Those with Long COVID symptoms lasting at least 1 year reported even poorer outcomes, particularly in general health, wellbeing and physical health.\u003c/p\u003e\n\u003cp\u003ePREMs showed no significant differences between Long COVID and non-Long COVID respondents overall. However, trust in healthcare system and person-centred care was significant lower when Long COVID patients still had these long-term symptoms at survey time.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn Belgium, adults with Long COVID report poorer health outcomes and less positive care experiences compared with those without Long COVID. These findings point to the substantial burden associated with Long COVID and to gaps in the current healthcare response to this emerging condition. Strengthening dedicated care pathways, improving coordination across services, and ensuring clear communication and support for patients will be essential to better address the needs of people living with Long COVID.\u003c/p\u003e","manuscriptTitle":"Investigating care outcomes and experiences of adults with Long COVID through patient- reported indicators (PROMs and PREMs) in Belgium","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 10:03:00","doi":"10.21203/rs.3.rs-8346443/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"110897912356727351764915603764674641306","date":"2026-05-10T16:20:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"265103894925120227174709693921997185219","date":"2026-05-06T15:03:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T12:58:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-08T17:06:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"100292448758411056591235890539514021280","date":"2026-03-04T16:13:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-04T15:03:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T22:13:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"244199877442463771111007331870307938653","date":"2026-03-02T22:00:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"207495411825329100360129534418435075517","date":"2026-03-02T10:20:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"311284368377341793421194753863286652016","date":"2026-03-02T09:44:03+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235494698826299739651762124752601220445","date":"2026-02-25T07:02:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-12-26T04:48:21+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-25T06:17:30+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-24T00:13:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-22T10:47:11+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2025-12-22T10:39:46+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cabc9311-19b8-4d79-8364-756525d74e99","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"110897912356727351764915603764674641306","date":"2026-05-10T16:20:39+00:00","index":139,"fulltext":""},{"type":"reviewerAgreed","content":"265103894925120227174709693921997185219","date":"2026-05-06T15:03:15+00:00","index":136,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-30T10:03:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 10:03:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8346443","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8346443","identity":"rs-8346443","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}