{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:27:49Z","timestamp":1792787269633,"version":"4.5.0"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T00:00:00Z","timestamp":1663804800000},"content-version":"unspecified","delay-in-days":21,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Bavarian State Ministry of Science and the Arts","award":["H.4001.1.7-53-7-TUME-FME-AM0HA"],"award-info":[{"award-number":["H.4001.1.7-53-7-TUME-FME-AM0HA"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2022,9,13]]},"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To estimate the treatment incidence of post-COVID syndrome (postinfectious sequelae present at least 12 weeks following infection) in the context of ambulatory care in Bavaria, Germany, and to establish whether related diagnoses occur more frequently than in patients with no known history of COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective cohort analysis of routinely collected claims data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Ambulatory care in Bavaria, Germany, observed from January 2020 to March 2022 (data accessed May 2022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>391 990 patients with confirmed COVID-19 diagnosis, 62 659 patients with other respiratory infection and a control group of 659 579 patients with no confirmed or suspected diagnosis of COVID-19.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Primary outcome is diagnosis of post-COVID syndrome documented in ambulatory care. Secondary outcomes are: chronic fatigue syndrome, psychological disorder, fatigue, mild cognitive impairment, disturbances of taste and smell, dyspnoea, pulmonary embolism and myalgia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among all patients with confirmed COVID-19, 14.2% (95% CI 14.0% to 14.5%) received a diagnosis of a post-COVID syndrome, and 6.7% (95% CI 6.5% to 6.9%) received the diagnosis in at least two quarterly periods during a 2-year follow-up. Compared with patients with other respiratory infections and with controls, patients with COVID-19 more frequently received a variety of diagnoses including chronic fatigue syndrome (1.6% vs 0.6% and 0.3%, respectively), fatigue (13.3% vs 9.2% and 6.0%), dyspnoea (9.9% vs 5.1% and 3.2%) and disturbances of taste and smell (3.2% vs 1.2% and 0.5%). The treatment incidence of post-COVID syndrome was highest among adults aged 40\u201359 (19.0%) and lowest among children aged below 12 years (2.6%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our results demonstrate a moderately high incidence of post-COVID syndrome 2 years after COVID-19 diagnosis. There is an urgent need to find efficient and effective solutions to help patients with dyspnoea, fatigue, cognitive impairment and loss of smell. Guidelines and treatment algorithms, including referral criteria, and occupational and physical therapy, require prompt and coherent implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2022-064979","type":"journal-article","created":{"date-parts":[[2022,9,22]],"date-time":"2022-09-22T12:19:15Z","timestamp":1663849155000},"page":"e064979","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Incidence of post-COVID syndrome and associated symptoms in outpatient care in Bavaria, Germany: a retrospective cohort study using routinely collected claims data"],"prefix":"10.1136","volume":"12","author":[{"given":"Ewan","family":"Donnachie","sequence":"first","affiliation":[{"name":"Bavarian Association of Statutory Health Insurance Physicians, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hapfelmeier","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany"},{"name":"Institute of AI and Informatics in Medicine, TUM School of Medicine, Technical University Munich, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Linde","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Tauscher","sequence":"additional","affiliation":[{"name":"Bavarian Association of Statutory Health Insurance Physicians, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Gerlach","sequence":"additional","affiliation":[{"name":"Bavarian Association of Statutory Health Insurance Physicians, M\u00fcnchen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Greissel","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2847-8626","authenticated-orcid":false,"given":"Antonius","family":"Schneider","sequence":"additional","affiliation":[{"name":"Institute of General Practice and Health Services Research, TUM School of Medicine, Technical University Munich, Munich, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,9,22]]},"reference":[{"key":"2025121514001786000_12.9.e064979.1","unstructured":"Ayoubkhani D . Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK - Office for National Statistics. Office for National Statistics, 2021. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk\/1april2021 [Accessed April 2022]."},{"key":"2025121514001786000_12.9.e064979.2","doi-asserted-by":"publisher","DOI":"10.1055\/a-1551-9734"},{"key":"2025121514001786000_12.9.e064979.3","unstructured":"Ayoubkhani D , Pawelek P . Prevalence of ongoing symptoms following coronavirus (COVID-19) infection in the UK: 7 April, 2022. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/healthandsocialcare\/conditionsanddiseases\/bulletins\/prevalenceofongoingsymptomsfollowingcoronaviruscovid19infectionintheuk\/7april2022 [Accessed April 2022]."},{"key":"2025121514001786000_12.9.e064979.4","unstructured":"Long COVID: the NHS plan for 2021\/22. NHS England and NHS improvement, 2021. Available: https:\/\/www.england.nhs.uk\/coronavirus\/publication\/long-covid-the-nhs-plan-for-2021-22\/ [Accessed April 2022]."},{"key":"2025121514001786000_12.9.e064979.5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m3026"},{"key":"2025121514001786000_12.9.e064979.6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n1648"},{"key":"2025121514001786000_12.9.e064979.7","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.jare.2021.11.013","article-title":"Analysis of post COVID-19 condition and its overlap with myalgic Encephalomyelitis\/Chronic fatigue syndrome","volume":"40","author":"Sukocheva","year":"2022","journal-title":"J Adv Res"},{"key":"2025121514001786000_12.9.e064979.8","unstructured":"State of Health in the EU . OECD\/European Observatory on health systems and policies. Germany: Country Health Profile, OECD Publishing, 2019."},{"key":"2025121514001786000_12.9.e064979.9","first-page":"425","article-title":"Patients with somatoform disorders are prone to expensive and potentially harmful medical procedures","volume":"118","author":"Schneider","year":"2021","journal-title":"Dtsch Arztebl Int"},{"key":"2025121514001786000_12.9.e064979.10","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1396815"},{"key":"2025121514001786000_12.9.e064979.11","unstructured":"Donnachie E . Coding the Covid-19 pandemic in Germany, 2021. Available: https:\/\/edonnachie.github.io\/ICD10gm\/articles\/coding_covid-19.html [Accessed April 2022]."},{"key":"2025121514001786000_12.9.e064979.12","doi-asserted-by":"publisher","DOI":"10.2307\/2281868"},{"key":"2025121514001786000_12.9.e064979.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2012.12.001"},{"key":"2025121514001786000_12.9.e064979.14","unstructured":"R Core Team . R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2021. https:\/\/www.R-project.org\/"},{"key":"2025121514001786000_12.9.e064979.15","doi-asserted-by":"crossref","unstructured":"Donnachie E . ICD10gm: metadata processing for the German modification of the ICD-10 coding system 2019.","DOI":"10.32614\/CRAN.package.ICD10gm"},{"key":"2025121514001786000_12.9.e064979.16","unstructured":"Therneau TM . A package for survival analysis in S, 2015. Available: https:\/\/CRAN.R-project.org\/package=survival [Accessed April 2022]."},{"key":"2025121514001786000_12.9.e064979.17","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2017-313713"},{"key":"2025121514001786000_12.9.e064979.18","article-title":"Global prevalence of post COVID-19 condition or long COVID: a meta-analysis and systematic review","volume":"16","author":"Chen","year":"2022","journal-title":"J Infect Dis"},{"key":"2025121514001786000_12.9.e064979.19","first-page":"175","article-title":"The prevalence of persistent symptoms after COVID-19 disease","volume":"119","author":"Lackermair","year":"2022","journal-title":"Dtsch Arztebl Int"},{"key":"2025121514001786000_12.9.e064979.20","first-page":"167","article-title":"Persisting symptoms after COVID-19","volume":"119","author":"F\u00f6rster","year":"2022","journal-title":"Dtsch Arztebl Int"},{"key":"2025121514001786000_12.9.e064979.21","first-page":"553","article-title":"Functional somatic symptoms","volume":"116","author":"Roenneberg","year":"2019","journal-title":"Dtsch Arztebl Int"},{"key":"2025121514001786000_12.9.e064979.22","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0000000000003328"},{"key":"2025121514001786000_12.9.e064979.23","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003773"},{"key":"2025121514001786000_12.9.e064979.24","doi-asserted-by":"crossref","unstructured":"Roessler M , Tesch F , Batram M . Post COVID-19 in children, adolescents, and adults: results of a matched cohort study including more than 150,000 individuals with COVID-19. MedRxiv 2021:21265133 https:\/\/www.medrxiv.org\/content\/ doi:10.1101\/2021.10.21.21265133","DOI":"10.1101\/2021.10.21.21265133"},{"key":"2025121514001786000_12.9.e064979.25","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1038\/s41591-022-01689-3","article-title":"Long-Term cardiovascular outcomes of COVID-19","volume":"28","author":"Xie","year":"2022","journal-title":"Nat Med"},{"key":"2025121514001786000_12.9.e064979.26","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1038\/s41586-021-03553-9","article-title":"High-Dimensional characterization of post-acute sequelae of COVID-19","volume":"594","author":"Al-Aly","year":"2021","journal-title":"Nature"},{"key":"2025121514001786000_12.9.e064979.27","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1038\/s41586-022-04569-5","article-title":"SARS-CoV-2 is associated with changes in brain structure in UK Biobank","volume":"604","author":"Douaud","year":"2022","journal-title":"Nature"},{"key":"2025121514001786000_12.9.e064979.28","doi-asserted-by":"crossref","DOI":"10.2340\/16501977-2776","article-title":"Rehabilitation setting during and after Covid-19: an overview on recommendations","volume":"53","author":"Agostini","year":"2021","journal-title":"J Rehabil Med"},{"key":"2025121514001786000_12.9.e064979.29","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1159\/000522118","article-title":"Outpatient pulmonary rehabilitation in patients with long COVID improves exercise capacity, functional status, dyspnea, fatigue, and quality of life","volume":"101","author":"Nopp","year":"2022","journal-title":"Respiration"},{"key":"2025121514001786000_12.9.e064979.30","first-page":"261","article-title":"Early pulmonary rehabilitation in COVID-19 disease","volume":"119","author":"Schindler","year":"2022","journal-title":"Dtsch Arztebl Int"},{"key":"2025121514001786000_12.9.e064979.31","doi-asserted-by":"crossref","DOI":"10.1177\/14799731211015691","article-title":"Early experiences of rehabilitation for individuals post-COVID to improve fatigue, breathlessness exercise capacity and cognition - A cohort study","volume":"18","author":"Daynes","year":"2021","journal-title":"Chron Respir Dis"},{"key":"2025121514001786000_12.9.e064979.32","first-page":"1","article-title":"Post-COVID: effects of physical exercise on functional status and work ability in health care personnel","author":"Hasenoehrl","year":"2022","journal-title":"Disabil Rehabil"},{"key":"2025121514001786000_12.9.e064979.33","article-title":"Interventions for the treatment of persistent post-COVID-19 olfactory dysfunction","volume":"9","author":"O'Byrne","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121514001786000_12.9.e064979.34","doi-asserted-by":"publisher","DOI":"10.3399\/BJGP.2021.0301"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2022-064979","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T22:00:24Z","timestamp":1765836024000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2022-064979"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2022,9,22]]},"published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1136\/bmjopen-2022-064979"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2022-064979","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9]]}}}