Background: The usefulness of telemedicine in the management of the coronavirus disease 2019 (COVID-19) pandemic has not been evaluated. Methods: We conducted a descriptive study of the process of recruitment and follow-up of patients using a telemedicine tool (TELEA) in the management of patients at risk, in a rural environment with a dispersed population in Lugo in north western Spain. Results: A large number of patients diagnosed with COVID-19 infection (N = 545) were evaluated. Of this group, 275 had comorbidities and were enrolled in the program, with a mean age of 57.6-16.3 years, 43.1% male. The risk factors were hypertension (38%), diabetes (16%), asthma (9.5%), heart disease (8.8%), and immunosuppression (5.1%). Patients were followed through the platform with daily control of symptoms and vital signs. Only 8% were admitted to the hospital, 5.1% on a scheduled basis and 2.9% through the emergency room. Conclusion: The telemedicine tool TELEA is useful for the management of high-risk patients with COVID-19.
Introduction This study was aimed to identify risk factors associated with unfavorable outcomes (composite outcome variable: mortality and need for mechanical ventilation) in patients hospitalized in Galicia with COVID-19 pneumonia. Methods Retrospective, multicenter, observational study carried out in the 8 Galician tertiary hospitals. All Patients admitted with confirmed COVID-19 pneumonia from 1st of March to April 24th, 2020 were included. A multivariable logistic regression analysis was performed in order to identify the relationship between risk factors, therapeutic interventions and the composite outcome variable. Results A total of 1292 patients (56.1% male) were included. Two hundred and twenty-five (17.4%) died and 327 (25.3%) reached the main outcome variable. Age [odds ratio (OR) = 1.03 (95% confidence interval (CI): 1.01–1.04)], CRP quartiles 3 and 4 [OR = 2.24 (95% CI: 1.39–3.63)] and [OR = 3.04 (95% CI: 1.88–4.92)], respectively, Charlson index [OR = 1.16 (95%CI: 1.06–1.26)], SaO2 upon admission [OR = 0.93 (95% CI: 0.91–0.95)], hydroxychloroquine prescription [OR = 0.22 (95%CI: 0.12–0.37)], systemic corticosteroids prescription [OR = 1.99 (95%CI: 1.45–2.75)], and tocilizumab prescription [OR = 3.39 (95%CI: 2.15–5.36)], significantly impacted the outcome. Sensitivity analysis using different alternative logistic regression models identified consistently the ratio admissions/hospital beds as a predictor of the outcome [OR = 1.06 (95% CI: 1.02–1.11)]. Conclusion These findings may help to identify patients at hospital admission with a higher risk of death and may urge healthcare authorities to implement policies aimed at reducing deaths by increasing the availability of hospital beds.
ORIGINALAnálisis de un modelo de asistencia clínica compartida con internistas en un servicio de cirugía vascular Analysis of a comanagement clinical model with internists in a vascular surgery department ResumenObjetivo: valorar si la asistencia clínica compartida entre cirujanos vasculares e internistas mejora la calidad de la atención médica prestada a pacientes ingresados en un servicio de cirugía vascular.Material y método: se analizaron diversas características clínicas relativas a la atención de una muestra de pacientes con patología arterial y con TVP ingresados en el servicio de cirugía vascular del hospital universitario Lucus Augusti de Lugo, tras la implantación de un modelo de asistencia multidisciplinar con internistas durante el año 2013. Los datos de los enfermos con TVP se compararon con los de controles históricos del año anterior. Por otra parte, se realizó una encuesta de satisfacción al personal sanitario del servicio de cirugía vascular sobre sus preferencias respecto al modelo de atención.Resultados: se estudiaron 50 pacientes con patología arterial y 75 con TVP (25 casos y 50 controles). Entre los primeros, su edad fue 71.9 años (DE 14), 60% hombres. Recibían una media de 8.2 fármacos (DE 4.4), su índice de Charlson fue 4.1 (DE 2.7) y el índice de Barthel 85.9 (DE 20). El 70% tenía anemia al ingreso y el 86% presentó alguna complicación durante el ingreso, con una mortalidad del 10%.Los pacientes con TVP atendidos por el modelo de asistencia compartida presentaron una mayor frecuencia de identificación de factores de riesgo de trombosis (76% vs 38%; p=0.002), de ajuste correcto de dosis de HBPM al peso y función renal (92% vs 18%; p=0.0001) y de registro completo de comorbilidad (100% vs 50%; p=0.0001), sin diferencias en la estancia media hospitalaria.Tanto el personal facultativo como el de enfermería prefirieron el modelo de asistencia compartida con internistas respecto al estándar.Conclusiones: los enfermos con patología arterial y venosa presentan una comorbilidad y riesgo de complicaciones que justifica la participación de internistas en su atención. El modelo de asistencia compartida puede mejorar la calidad de la asistencia prestada, con un elevado grado de satisfacción entre el personal del equipo quirúrgico.Palabras clave: asistencia compartida, medicina interna, cirugía vascular Abstract Objective: to assess whether clinical comanagement between vascular surgeons and internists improves the quality of care provided to patients admitted to a vascular surgery service.Material and method: several clinical features related to the clinical care provided to a sample of patients with arterial disease and DVT admitted to the vascular surgery at Lucus Augusti University Hospital of Lugo were analyzed, after implementation of a comanagement model of care involving internists during the year 2013. Data of patients with DVT were compared with historical controls of the year before. Moreover, we conducted a satisfaction survey to the medical staff and nursing of the vascular surgery servi...
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