Clinical learnings from a virtual primary care program monitoring mild to moderate COVID-19 patients at home

Abstract

Background Virtual consults have replaced in-person visits for many home-isolated patients with COVID-19 disease. Objectives To describe the natural history, clinical management and outcomes of community-dwelling patients with COVID-19, who received support from a family medicine-led, virtual CovidCare@Home program in Toronto, Ontario, Canada. Methods Observational, descriptive study conducted by retrospective chart review of 98 patients enrolled during the first 5 weeks of program implementation (8 April–11 May 2020); 73 patients with laboratory-confirmed COVID-19, with symptom onset ≤ 14 days before initial consult were included for analysis. Patients were classified as mild, moderate or severe based on WHO Criteria. Results All patients in the program experienced mild (88%) or moderate (12.3%) disease. No patients were hospitalized or died. Patients were mainly female (70%); with mean age of 43.3 years. Most patients (82.2%) worked in higher risk, healthcare settings. Almost 40% had no medical co-morbidities. Common symptoms were cough (65.8%), fatigue (60.3%), headache (42.5%) and myalgia (39.7%), followed by fever (32.9%), sore throat (21.9%), nasal congestion (21.9%) and rhinorrhea (20.5%). Headache (51%) and anosmia (45.1%) were common among females; fever and breathlessness among males (40.9%). Nine patients (12.3%) experienced worsening of symptoms (mainly respiratory) or exacerbation of co-morbidities, which required care outside the virtual service. Conclusion Patients with mild to moderate COVID-19 disease can be managed safely and effectively in a family medicine-led virtual program. Some sex differences in symptoms were observed. Future work should focus on long-term follow up in view of the existence of so-called ‘long-haulers’.

Telemedicine monitoring of high-risk coronavirus disease 2019 (COVID-19) patients by Family Medicine service after discharge from the Emergency Department

“…[ 8 9 ] TMSs have been widely adopted across the globe for low-risk COVID-19 patients with mild disease to mitigate hospitalizations, but these low-risk patients represent only a fraction of the actual deaths. [ 10 11 13 ] Our study is unique as it focuses on telemonitoring of mild-to-moderate COVID-19 patients at high risk of disease progression and shows that these patients have outcomes comparable to similar patients admitted to hospital. This potential new role of telemedicine can have a huge impact on resource utilization in hospitals overwhelmed in COVID-19 hot spots.…”

“…Telemedicine service (TMS) came to the rescue early in the COVID-19 pandemic throughout the world, Saudi Arabia not excepted, and was successfully used both in primary as well as tertiary care ambulatory settings to reduce personal visits to the clinics. [ 10 11 12 ] The scope of the TMSs was then expanded and found to be helpful in monitoring large scale general populations, follow- up on low-risk symptomatic patients discharged from the ED, as well as COVID-19 patients after their hospital discharge, to decrease the rates of ED revisits and hospital admissions. [ 12 13 14 15 ] However, these studies excluded high-risk patients with pre-existing comorbidities.…”

Telemedicine and virtual respiratory care in the era of COVID-19

“…Community-based telemonitoring of symptoms scores, temperature, oximetry, and blood pressure supported by self-management information and/or remote monitoring proved to be a cost-effective alternative to hospitalisation. [15,16,18,[154][155][156][157][158] Although a rapid systematic review was unable to confirm safety due to lack of standardised reporting, [18] mixed-method evaluation of individual programmes concluded that they were reassuring to patients (especially the oximetry), [15,155,158] acceptable to clinicians, [15,154,158] able to detect signs of deterioration, [15,158,159] and a safe approach for selected high-risk patients with mild-to-moderate COVID-19. [15,16,18,[157][158][159] Economic analysis was limited to reporting resources used and the amount spent per patient monitored.…”

A journal of the 2020 plague year

“…I was redeployed with some of my colleagues, to set up and run a family medicineled virtual COVID-19 clinic in my hospital. In addition to the camaraderie and rewards of teamwork, 3 we were able to demonstrate that, in spite of limited experience with COVID-19, we were able to effectively and safely care for patients 4 and share what we learned with a larger audience.…”