Evolution of a Cohort of COVID-19 Infection Suspects Followed-Up from Primary Health Care

Abstract

Diagnosis and home follow-up of patients affected by COVID-19 is being approached by primary health care professionals through telephone consultations. This modality of teleconsultation allows one to follow the evolution of patients and attend early to possible complications of the disease. The purpose of the study was to analyze the evolution of a cohort of patients with suspected SARS-CoV-2 disease followed by primary care professionals and to determine the factors that are associated with hospital admission. A prospective cohort study was carried out on 166 patients selected by consecutive sampling that showed symptoms compatible with COVID-19. The follow-up was approached via telephone for 14 days analyzing hospitalization and comorbidities of the patients. There were 75% of the hospitalized patients that were male (p = 0.002), and 70.8% presented comorbidities (p < 0.001). In patients with diabetes, the risk of hospitalization was 4.6-times larger, in hypertension patients it was 3.3-times, those suffering from renal insufficiency 3.8-times, and immunosuppressed patients 4.8-times (IC 95%: 1.9–11.7). In 86.7% of the cases, clinical deterioration was diagnosed in the first seven days of the infection, and 72% of healing was reached from day seven to fourteen. Monitoring from primary care of patients with COVID-19 allows early diagnosis of clinical deterioration and detection of comorbidities associated with the risk of poor evolution and hospital admission.

What has the COVID-19 pandemic taught us about the use of virtual consultations in primary care?

“…8,15,16 The limitations of telephone consultations were acknowledged; they did not support complex clinical assessment 8 and were considered less personal, with less capacity to read body language, build rapport and meet patient needs. 14,15 However, between March and September 2020, telephone consultations were considered a valuable, safe and resource-friendly alternative to in-person visits when following up and monitoring suspected COVID-19 patients in domiciliary care; 17 for the short-term provision of direct-to-patient medical abortion services, including assessment and counselling; 18 and for maintaining glycaemic control in patients with suboptimal control of type 2 diabetes. 19 Research conducted between April and July 2020 found that the quality of consultations was influenced by a variety of factors, including mismatches between patient preferences and provider perceptions of suitability, patient multitasking while undertaking consultations, interoperability challenges and equipment availability and performance issues.…”

Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review

“…The studies covered 18 countries that used digital strategies in PHC; 18 studies were performed in North America (United States [ 29 - 43 ] and Canada [ 44 - 46 ]), 4 studies were performed in South America (Brazil [ 47 - 50 ]), 14 studies were performed in Europe (England [ 51 - 53 ], United Kingdom [ 54 , 55 ], Spain [ 56 , 57 ], Belgium [ 58 , 59 ], Norway [ 60 ], Portugal [ 61 ], Romania [ 62 ], Germany [ 63 ], and Poland [ 64 ]), four studies were performed in Asia (Israel [ 65 ], Oman [ 66 ], Saudi Arabia [ 67 ], and Iran [ 68 ]), and four studies were performed in Oceania (Australia [ 69 - 71 ] and New Zealand [ 72 ]). The characteristics of studies and distribution of countries that used digital strategies in PHC are described in Table 1 and Figure 2 , respectively.…”

“…Actions were mostly directed to the general public (ie, any health status or characteristic) [ 29 , 31 , 32 , 34 - 36 , 38 , 40 - 42 , 44 , 46 , 48 , 49 , 51 , 53 , 55 , 56 , 58 - 60 , 63 , 67 , 71 ]. Regarding professionals who conducted the actions, the majority were clinicians [ 29 - 31 , 34 , 36 - 38 , 42 , 44 - 46 , 49 - 51 , 54 , 55 , 57 , 58 , 60 , 63 - 66 , 69 , 71 , 72 ] and nurses [ 35 , 39 , 41 , 43 , 47 , 48 , 56 , 70 , 72 ]. Actions were directed toward people with and without COVID-19 [ 31 , 32 , 34 , 36 , 38 , 40 , 42 , 44 , 49 , 51 , 53 - 56 , 58 - 63 , 65 , 67 , <...>…”

“…The clinical modality was the most commonly reported [ 29 - 31 , 33 , 36 - 38 , 40 - 46 , 48 - 52 , 54 , 58 - 60 , 63 , 65 - 67 , 69 , 71 , 72 ], referring to the following actions: consultations, renewal of medical prescriptions, exams, follow-up, health guidelines, issuance of certificates, treatments, screening, monitoring, diagnosis, management of chronic conditions, referrals, clinical self-monitoring, and risk classification. Remote consultation associated with in-person actions was the most prevalent model [ 29 - 32 , 34 - 38 , 40 , 42 - 46 , 49 , 51 , 53 , 54 , 56 , 57 , 60 - 64 , 67 ].…”

A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19

“…Yet, a variable proportion of patients will develop more severe forms of the infection that range from mild oxygen-requiring interstitial pneumonia to a devastating respiratory distress syndrome with multiorgan failure, whereby hospital or even intensive care unit admission is necessary to provide invasive mechanical ventilation as well as hemodynamic support ( 2 ). Telemedicine strategies to follow COVID-19 patients include telephone ( 3 , 4 , 5 ) or video calling ( 6 ), smartphone applications ( 7 ), robotic calls based on artificial intelligence technology ( 8 ) and home-based patient units that enable real-time monitoring of clinical parameters such as oxygen saturation, heart rate, body temperature, and peak expiratory flow ( 9 , 10 ).…”