Long COVID Leaves Lasting Mark on Health and Care Trust in Belgian Adults, Survey Finds

Long COVID continues to cast a long shadow over primary care in Belgium, according to a new study that draws on one of the most systematic attempts anywhere in Europe to capture how patients themselves experience the condition. Researchers from Sciensano, the Walloon Institute for Evaluation, Foresight and Statistics, and UCLouvain analyzed self-reported data from 4,687 primary care patients aged 45 and older, collected between March 2023 and January 2024 as part of the Organisation for Economic Co-operation and Development’s Patient-Reported Indicator Surveys, known as PaRIS. Their findings, published in BMC Health Services Research, show that roughly one in eight older primary care users in Belgium lives with Long COVID, and that these patients rate their own health markedly lower than comparable patients who never developed the condition.

The scale of the problem emerges clearly from the numbers. Half of the surveyed patients, 2,359 individuals, reported a previous COVID-19 infection diagnosis. Among those, more than one in four, 605 people, said they were still experiencing Long COVID-related symptoms lasting two months or longer after their infection. That translates into a Long COVID prevalence of 12.9 percent among primary care users aged 45 years and older in Belgium, a striking figure for a condition that was barely recognized in clinical guidelines only a few years ago. Because the study population consists of people already in contact with general practices, the authors caution that the estimate speaks specifically to the burden carried within primary care, but that burden is clearly substantial.

The methodological backbone of the study is the PaRIS initiative, which the OECD developed to allow countries to compare how well their health systems serve people living with chronic conditions. Rather than relying solely on clinical measurements or administrative records, PaRIS collects patient-reported outcome measures, or PROMs, which capture how patients rate their general health, wellbeing, and physical and mental health, alongside patient-reported experience measures, or PREMs, which assess dimensions such as trust in the healthcare system and whether care feels person-centred. Belgium contributed to the international survey by recruiting patients through general practices, giving researchers a rare window into the day-to-day reality of chronic illness as patients themselves perceive it.

To identify who develops Long COVID and what it costs them, the research team applied two complementary statistical approaches. Multivariate models were used to examine the clinical and sociodemographic determinants of the condition, adjusting for a range of factors that could confound the association. Mixed-effects models were then applied to compute ten key PROM and PREM indicators following the PaRIS10 methodology, a standardized framework designed to make results comparable across countries. Crucially, these models accounted for the hierarchical structure of the data, with patients nested within general practitioner practices, ensuring that differences between practices did not distort the estimates of individual-level effects.

The determinants of Long COVID that emerged from the analysis paint a consistent picture. Female sex, age between 45 and 54 years, lower educational level, multiple chronic conditions, and higher body mass index were all associated with having Long COVID. The finding that women and middle-aged adults carry a disproportionate share of the condition echoes patterns reported in many other studies, while the role of educational level points to possible socioeconomic gradients in either infection exposure, access to care, or the likelihood of persistent symptoms being recognized and recorded. The association with multimorbidity and elevated BMI suggests that patients already managing chronic health problems face an elevated risk of their infection leaving a lasting imprint.

When the researchers compared patient-reported outcomes, the differences between the two groups were stark. Primary care patients aged 45 and older with Long COVID reported significantly lower PROM scores for general health, wellbeing, and both physical and mental health compared with respondents who had not developed the condition. In other words, even after accounting for the fact that these are all patients with chronic conditions attending general practices, those with Long COVID consistently rated their lives as worse across every domain measured. The multisystemic nature of the condition, which can affect the cardiovascular, respiratory, neurological, and other body systems, is reflected in this broad deterioration rather than in any single narrow deficit.

Duration mattered as well. Patients whose Long COVID symptoms had persisted for at least one year reported even poorer outcomes than those with shorter symptom duration, with the sharpest declines seen in general health, wellbeing, and physical health. This gradient suggests that for a substantial group of patients, Long COVID is not a transitional phase that resolves within months but a chronic state that erodes functioning over time. From a health services perspective, it implies that the demand these patients place on primary care is not a temporary surge that will dissipate as the pandemic recedes, but a durable feature of the patient population that care systems will need to plan for.

The experience measures told a more nuanced story. Overall, PREMs showed no significant differences between Long COVID and non-Long COVID respondents, indicating that patients with the condition did not broadly rate their care interactions worse than others. However, the picture changed for those still experiencing long-term symptoms at the time of the survey: trust in the healthcare system and perceptions of person-centred care were significantly lower among these patients. This distinction matters because it suggests that the frustration of people with active, ongoing symptoms is not diffuse dissatisfaction but a specific signal that the system is not yet meeting their needs, whether through fragmented pathways, unclear communication, or limited access to dedicated Long COVID services.

The authors conclude that adults with Long COVID in Belgian primary care report poorer health outcomes and less positive care experiences than those without the condition, and they argue that the findings point to the need for more tailored, person-centred care. Strengthening dedicated care pathways, improving coordination across services, and ensuring clear communication and support for patients are identified as essential steps for better addressing the needs of people living with the condition. The study was funded by the Belgian National Institute for Health and Disability Insurance, and the corresponding author is Sarah Moreels of Sciensano in Brussels.

Beyond Belgium, the study demonstrates the value of patient-reported indicators as a surveillance tool for post-acute infection conditions. Because PROMs and PREMs are collected through standardized questionnaires rather than laboratory tests, they can capture the functional and experiential toll of a condition that often lacks objective diagnostic markers, and the PaRIS10 framework allows that toll to be benchmarked internationally. As health systems across high-income countries confront the same growing population of patients with persistent post-COVID symptoms, the Belgian experience suggests that listening systematically to patients, and acting on what they report about both their health and their care, will be central to building services that this group can actually trust.

Subject of Research: Patient-reported outcomes and care experiences of adults with Long COVID in Belgian primary care

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

Article References: Moreels, S., Ekelson, R., Smith, P., Speybroeck, N., Bensemmane, S., De Schreye, R., & Annaert, D. (2026). Investigating care outcomes and experiences of adults with Long COVID through patient-reported indicators (PROMs and PREMs) in Belgium. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15783-6

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15783-6

Keywords: Long COVID, patient-reported outcome measures, PROMs, PREMs, primary care, Belgium, PaRIS, health services research, chronic conditions, person-centred care, OECD, multimorbidity