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Nirmalarajah K, Aftanas P, Barati S, Chien E, Crowl G, Faheem A, Farooqi L, Jamal AJ, Khan S, Kotwa JD, Li AX, Mozafarihashjin M, Nasir JA, Shigayeva A, Yim W, Yip L, Zhong XZ, Katz K, Kozak R, McArthur AG, Daneman N, Maguire F, McGeer AJ, Duvvuri VR, Mubareka S. Identification of patient demographic, clinical, and SARS-CoV-2 genomic factors associated with severe COVID-19 using supervised machine learning: a retrospective multicenter study. BMC Infect Dis 2025; 25:132. [PMID: 39875869 PMCID: PMC11773898 DOI: 10.1186/s12879-025-10450-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 01/06/2025] [Indexed: 01/30/2025] Open
Abstract
BACKGROUND Drivers of COVID-19 severity are multifactorial and include multidimensional and potentially interacting factors encompassing viral determinants and host-related factors (i.e., demographics, pre-existing conditions and/or genetics), thus complicating the prediction of clinical outcomes for different severe acute respiratory syndrome coronavirus (SARS-CoV-2) variants. Although millions of SARS-CoV-2 genomes have been publicly shared in global databases, linkages with detailed clinical data are scarce. Therefore, we aimed to establish a COVID-19 patient dataset with linked clinical and viral genomic data to then examine associations between SARS-CoV-2 genomic signatures and clinical disease phenotypes. METHODS A cohort of adult patients with laboratory confirmed SARS-CoV-2 from 11 participating healthcare institutions in the Greater Toronto Area (GTA) were recruited from March 2020 to April 2022. Supervised machine learning (ML) models were developed to predict hospitalization using SARS-CoV-2 lineage-specific genomic signatures, patient demographics, symptoms, and pre-existing comorbidities. The relative importance of these features was then evaluated. RESULTS Complete clinical data and viral whole genome level information were obtained from 617 patients, 50.4% of whom were hospitalized. Notably, inpatients were older with a mean age of 66.67 years (SD ± 17.64 years), whereas outpatients had a mean age of 44.89 years (SD ± 16.00 years). SHapley Additive exPlanations (SHAP) analyses revealed that underlying vascular disease, underlying pulmonary disease, and fever were the most significant clinical features associated with hospitalization. In models built on the amino acid sequences of functional regions including spike, nucleocapsid, ORF3a, and ORF8 proteins, variants preceding the emergence of variants of concern (VOCs) or pre-VOC variants, were associated with hospitalization. CONCLUSIONS Viral genomic features have limited utility in predicting hospitalization across SARS-CoV-2 diversity. Combining clinical and viral genomic datasets provides perspective on patient specific and virus-related factors that impact COVID-19 disease severity. Overall, clinical features had greater discriminatory power than viral genomic features in predicting hospitalization.
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Affiliation(s)
- Kuganya Nirmalarajah
- Sunnybrook Research Institute, Toronto, ON, Canada
- Public Health Ontario, 661 University Avenue, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | | | - Emily Chien
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | | | - Saman Khan
- Sinai Health System, Toronto, ON, Canada
| | | | - Angel X Li
- Sinai Health System, Toronto, ON, Canada
| | | | - Jalees A Nasir
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | | | - Winfield Yim
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Lily Yip
- Sunnybrook Research Institute, Toronto, ON, Canada
| | | | - Kevin Katz
- Shared Hospital Laboratory, Toronto, ON, Canada
- North York General Hospital, Toronto, ON, Canada
| | - Robert Kozak
- Sunnybrook Research Institute, Toronto, ON, Canada
- Shared Hospital Laboratory, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Andrew G McArthur
- Michael G. DeGroote Institute for Infectious Disease Research, McMaster University, Hamilton, ON, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, Hamilton, ON, Canada
| | - Nick Daneman
- Sunnybrook Research Institute, Toronto, ON, Canada
| | - Finlay Maguire
- Sunnybrook Research Institute, Toronto, ON, Canada
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
- Department of Community Health & Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Allison J McGeer
- Sinai Health System, Toronto, ON, Canada
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Venkata R Duvvuri
- Public Health Ontario, 661 University Avenue, Toronto, ON, Canada.
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON, Canada.
| | - Samira Mubareka
- Sunnybrook Research Institute, Toronto, ON, Canada.
- Shared Hospital Laboratory, Toronto, ON, Canada.
- Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada.
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Krysov VA, Balshin ME, Azar EN, Cernioglo K, Perekopskiy D, Nurpeissova AT, Shi LZ. Overcoming Hesitancy and Barriers to Care with Integration of Telemedicine in a Free Student-run Health Clinic. J Prim Care Community Health 2025; 16:21501319251316338. [PMID: 39883478 PMCID: PMC11783495 DOI: 10.1177/21501319251316338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2024] [Revised: 01/03/2025] [Accepted: 01/08/2025] [Indexed: 01/31/2025] Open
Abstract
INTRODUCTION Nadezhda Clinic is a free student-run health clinic that provides culturally sensitive primary care services to the underserved Russian-speaking population of the greater Sacramento area. At the onset of the COVID-19 pandemic, the clinic suspended in-person services and solely offered telemedicine visits. Most patients were hesitant to utilize telemedicine due to poor technological literacy, privacy concerns, and a preference for in-person care. OBJECTIVE This quality improvement project aimed to evaluate whether the implementation of culturally sensitive telemedicine services and outreach strategies would help address patient hesitancy and barriers to care. METHODS Successful implementation of telemedicine was dependent on building trust with the community, providing multilingual technological assistance, and offering personalized support. Some measures that were reviewed in order to assess this included comparison of patient demographics, clinic attendance, and distance reached between in-person and telemedicine services. RESULTS Telemedicine implementation was associated with increased clinic attendance rates with a no-show rate as low as 13% when compared to in-person services with a no-show rate of 20%. Telehealth services also enabled the clinic to reach patients in rural areas up to 120 miles away. CONCLUSIONS With the implementation of a culturally sensitive telemedicine protocol, Nadezhda Clinic achieved greater patient retention rates and reached patients at further distances, suggesting an overall reduction in hesitancy and barriers to care. Free clinics offering telemedicine are critical to further address healthcare disparities in marginalized communities.
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Affiliation(s)
- Vikki A. Krysov
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | | | | | - Karina Cernioglo
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | - David Perekopskiy
- University of California, Davis School of Medicine, Sacramento, CA, USA
| | | | - Lucy Zhonglu Shi
- University of California, Davis, Division of Hospital Medicine, Sacramento, CA, USA
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Cornelis J, Christiaens W, de Meester C, Mistiaen P. Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review. JMIR Nurs 2024; 7:e44580. [PMID: 39287362 PMCID: PMC11615560 DOI: 10.2196/44580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 05/01/2023] [Accepted: 09/13/2024] [Indexed: 09/19/2024] Open
Abstract
BACKGROUND During the pandemic, health care providers implemented remote patient monitoring (RPM) for patients experiencing COVID-19. RPM is an interaction between health care professionals and patients who are in different locations, in which certain patient functioning parameters are assessed and followed up for a certain duration of time. The implementation of RPM in these patients aimed to reduce the strain on hospitals and primary care. OBJECTIVE With this literature review, we aim to describe the characteristics of RPM interventions, report on patients with COVID-19 receiving RPM, and provide an overview of outcome variables such as length of stay (LOS), hospital readmission, and mortality. METHODS A combination of different searches in several database types (traditional databases, trial registers, daily [Google] searches, and daily PubMed alerts) was run daily from March 2020 to December 2021. A search update for randomized controlled trials (RCTs) was performed in April 2022. RESULTS The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centers. None of the 164 studies covering 248,431 patients reported on the presence of a randomized control group. Studies described a "prehosp" group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and who were not hospitalized but closely monitored at home or a "posthosp" group (32 studies) with patients who were monitored at home after hospitalization for COVID-19. Moreover, 34 studies described both groups, and in 2 studies, the description was unclear. In the prehosp and posthosp groups, there were large variations in the number of emergency department (ED) visits (0%-36% and 0%-16%, respectively) and no convincing evidence that RPM leads to less or more ED visits or hospital readmissions (0%-30% and 0%-22%, respectively). Mortality was generally low, and there was weak to no evidence that RPM is associated with lower mortality. Moreover, there was no evidence that RPM shortens previous LOS. A literature update identified 3 small-scale RCTs, which could not demonstrate statistically significant differences in these outcomes. Most papers claimed savings; however, the scientific base for these claims was doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy). CONCLUSIONS Based on these results, there is no convincing evidence that RPM in COVID-19 patients avoids ED visits or hospital readmissions and shortens LOS or reduces mortality. On the other hand, there is no evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework.
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Bryant AD, Robinson TJ, Gutierrez-Perez JT, Manning BL, Glenn K, Imborek KL, Kuperman EF. Outcomes of a home telemonitoring program for SARS-CoV-2 viral infection at a large academic medical center. J Telemed Telecare 2024; 30:675-680. [PMID: 35275502 PMCID: PMC8919094 DOI: 10.1177/1357633x221086067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Telemedicine serves as a viable option during the COVID-19 pandemic to provide in-home care, maintain home isolation precautions, reduce unnecessary healthcare exposures, and de-burden hospitals. METHODS We created a novel telemedicine program to closely monitor patients infected with SARS-CoV-2 (COVID-19) at home. Adult patients with COVID-19 were enrolled in the program at the time of documented infection. Patients were followed by a team of providers via telephone or video visits at frequent intervals until resolution of their acute illness. Additionally, patients were stratified into high-risk and low-risk categories based on demographics and underlying comorbidities. The primary outcome was hospitalization after enrollment in the home monitoring program, including 30 days after discharge from the program. RESULTS Over a 3.5-month period, 1128 patients met criteria for enrollment in the home monitoring program. 30.7% were risk stratified as high risk for poor outcomes based on their comorbidities and age. Of the 1128 patients, 6.2% required hospitalization and 1.2% required ICU admission during the outcome period. Hospitalization was more frequent in patients identified as high risk (14.2% vs 2.7%, P < 0.001). DISCUSSION Enrollment in a home monitoring program appears to be an effective and sustainable modality for the ambulatory management of COVID-19.
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Affiliation(s)
- Andrew D Bryant
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Tommy J Robinson
- Internal Medicine Residency, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Bradley L Manning
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Glenn
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Ethan F Kuperman
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Farquhar D, Choong K, Anderson J, Peters S, Subedi S. Evaluation of a virtual ward model of care and readmission characteristics during the COVID-19 pandemic within an Australian tertiary hospital. Intern Med J 2024; 54:551-558. [PMID: 38064529 DOI: 10.1111/imj.16302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/18/2023] [Indexed: 04/20/2024]
Abstract
BACKGROUND Virtual ward (VW) models of care established during the coronavirus disease 2019 (COVID-19) pandemic provided safe and equitable provision of ambulatory care for low-risk patients; however, little is known about patients who require escalation of care to hospitals from VWs. AIM To assess our VW model of care and describe the characteristics of patients admitted to the hospital from the VW. METHODS Observational study of all patients admitted to a tertiary hospital COVID-19 VW between 1 December 2021 and 30 June 2022. Utilisation and epidemiological characteristics were assessed for all patients while additional demographics, assessments, treatments and outcomes were assessed for patients admitted to the hospital from the VW. RESULTS Of 9494 patient admissions, 269 (2.83%) patients identified as Aboriginal and Torres Strait Islander and 1774 (18.69%) were unvaccinated. The median length of stay was 5.10 days and the mean Index of Relative Socio-economic Advantage and Disadvantage decile was 5.73. One hundred sixty (1.69%) patients were admitted to the hospital from the VW, of which 25 were adults admitted to medical wards. Of this cohort, prominent comorbidities were obesity, hypertension, asthma and frailty, while the main symptoms on admission to the VW were cough, fatigue, nausea and sore throat. High Pandemic Respiratory Infection Emergency System Triage (PRIEST), Veterans Health Administration COVID-19 (VACO), COVID Home Safely Now (CHOSEN) and 4C mortality scores existed for those readmitted. CONCLUSIONS This VW model of care was both safe and effective when applied to a broad socioeconomic population during the COVID-19 pandemic. While readmission to the hospital was low, this study identified key characteristics of such presentations, which may assist future triaging, escalation and resource allocation within VWs during the COVID-19 pandemic and beyond.
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Affiliation(s)
- Drew Farquhar
- Infectious Disease Advanced Trainee, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Keat Choong
- Infectious Disease Physician, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - James Anderson
- Respiratory and Sleep Physician, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Sandra Peters
- Virtual Care Clinical Lead, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
| | - Shradha Subedi
- Infectious Disease Physician and Medical Microbiologist, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia
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Devlin MK, McIntyre NJ, Ramer MD, Kwon YH, Nicholson JM, Mrkobrada M, Kronick J, Calvin JE, Spicer E. Applying the lessons of design thinking: a unique programme of care for acutely unwell, community-dwelling COVID-19 patients. BMJ Open Qual 2024; 13:e002500. [PMID: 38413092 PMCID: PMC10900416 DOI: 10.1136/bmjoq-2023-002500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic limited access to primary care and in-person assessments requiring healthcare providers to re-envision care delivery for acutely unwell outpatients. Design thinking methodology has the potential to support the robust evolution of a new clinical model. AIM To demonstrate how design thinking methodology can rapidly and rigorously create and evolve a safe, timely, equitable and patient-centred programme of care, and to share valuable lessons for effective implementation of design thinking solutions to address complex problems. METHOD We describe how design thinking methodology was employed to create a new clinical model of care. Using the example of a novel telemedicine programme to support acutely unwell, community-dwelling COVID-19-positive patients called the London Urgent COVID-19 Care Clinic (LUC3), we show how continuous quality outcomes (safety, timeliness, equity and patient-centredness), as well as patient experience survey responses, can drive iterative changes in programme delivery. RESULTS The inspiration phase identified four key needs for this patient population: monitoring COVID-19 signs and symptoms; self-managing COVID-19 symptoms; managing other comorbidities in the setting of COVID-19; and escalating care as needed. Guided by these needs, a cross-disciplinary stakeholder group was engaged in the ideation and implementation phases to create a unique and comprehensive telemedicine programme (LUC3). During the implementation phase, LUC3 assessed 2202 community-based patients diagnosed with acute COVID-19; the collected quality outcomes and end-user feedback led to evolution of programme delivery. CONCLUSION Design thinking methodology provided an essential framework and valuable lessons for the development of a safe, equitable, timely and patient-centred telemedicine care programme. The lessons learnt here-the importance of inclusive collaboration, using empathy to guide equity-focused interventions, leveraging continuous metrics to drive iteration and aiming for good-if-not-perfect plans-can serve as a road map for using design thinking for targeted healthcare problems.
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Affiliation(s)
- Megan K Devlin
- Division of Infectious Diseases, Department of Medicine, Western University, London, Ontario, Canada
- Infectious Diseases Care Program, St Joseph's Health Care London, London, Ontario, Canada
| | - Natasha J McIntyre
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
| | - Matthew D Ramer
- Faculty of Health Sciences and Wellness, Humber College Institute of Technology and Advanced Learning, Toronto, Ontario, Canada
| | - Young Han Kwon
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
| | - J Michael Nicholson
- Division of Respirology, Department of Medicine, Western University, London, Ontario, Canada
| | - Marko Mrkobrada
- Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
| | - Jami Kronick
- Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - James E Calvin
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
| | - Erin Spicer
- Centre for Quality, Innovation and Safety, Western University, London, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, Western University, London, Ontario, Canada
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Ga’al A, Kapsack A, Mahmud A, Estrada-Codecido J, Lam P, Chan A, Andany N, Simor A, Kiss A, Daneman N. Predictors of later COVID-19 test seeking. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2024; 8:299-308. [PMID: 38250614 PMCID: PMC10797764 DOI: 10.3138/jammi-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/12/2023] [Accepted: 05/23/2023] [Indexed: 01/23/2024]
Abstract
Background Delays in COVID-19 testing may increase the risk of secondary household and community transmission. Little is known about what patient characteristics and symptom profiles are associated with delays in test seeking. Methods We conducted a retrospective cohort study of all symptomatic patients diagnosed with COVID-19 and assessed in a COVID Expansion to Outpatients (COVIDEO) virtual care program between March 2020 and June 2021. The primary outcome was later test seeking more than 3 days from symptom onset. Multivariable logistic regression was used to examine predictors of later testing including patient characteristics and symptoms (30 individual symptoms or 7 symptom clusters). Results Of 5,363 COVIDEO patients, 4,607 were eligible and 2,155/4,607 (46.8%) underwent later testing. Older age was associated with increased odds of late testing (adjusted odds ratio [aOR] 1.007/year; 95% CI 1.00 to 1.01), as was history of recent travel (aOR 1.4; 95% CI 1.01 to 1.95). Health care workers had lower odds of late testing (aOR 0.50; 95% CI 0.39 to 0.62). Late testing was associated with symptoms in the cardiorespiratory (aOR 1.2; 95% CI 1.05, 1.36), gastrointestinal (aOR = 1.2; 95% CI 1.04, 1.4), neurological (aOR 1.1; 95% CI 1.003, 1.3) and psychiatric (aOR 1.3; 95% CI 1.1, 1.5) symptom clusters. Among individual symptoms, dyspnea, anosmia, dysgeusia, sputum, and anorexia were associated with late testing; pharyngitis, myalgia, and headache were associated with early testing. Conclusion Certain patient characteristics and symptoms are associated with later testing, and warrant further efforts to encourage earlier testing to minimize transmission.
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Affiliation(s)
- Amal Ga’al
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abby Kapsack
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | | | - Philip Lam
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Adrienne Chan
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Nisha Andany
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Andrew Simor
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Alex Kiss
- Sunnybrook Research Institute, Toronto, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
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Sarsembayev B, Madyarov V, Kuzikeev M, Kurakbayev E, Utegaliev T. Coronavirus infection and systemic inflammatory reaction syndrome. POLSKI MERKURIUSZ LEKARSKI : ORGAN POLSKIEGO TOWARZYSTWA LEKARSKIEGO 2024; 52:60-66. [PMID: 38518235 DOI: 10.36740/merkur202401110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
OBJECTIVE Aim: The purpose of this study was a clinical approbation of the Kometad drug (international non-proprietary name sodium colistimethate), an antibiotic from the polymyxin group in patients with severe course of confirmed сoronavirus infection in the intensive care unit of the Branch of the I. Zhekenova Municipal Clinical Infectious Diseases Hospital.. PATIENTS AND METHODS Materials and Methods: The methodology is based on both theoretical and empirical methods of scientific cognition. During the study, the features of the Coronavirus infection and the inflammatory reaction syndrome were considered, which became quite a big problem during the pandemic. RESULTS Results: The main indications for the tested drug and the consequences of its use for one age group were also determined. CONCLUSION Conclusions: The conclusion was made about the positive dynamics of the patients' health status, and recommendations were given for further research in this area. The practical significance of this study lies in the first clinical approbation of the Kometad drug, which can be used in medicine to reduce the severity of the systemic inflammatory reaction syndrome and improve the patient's health as a result of the disease of Coronavirus infection, after further clinical trials of the drug with different age groups of patients.
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Affiliation(s)
| | | | - Marat Kuzikeev
- KAZAKH RUSSIAN MEDICAL UNIVERSITY, ALMATY, REPUBLIC OF KAZAKHSTAN
| | - Edil Kurakbayev
- KAZAKHSTAN MEDICAL UNIVERSITY "HIGHER SCHOOL OF PUBLIC HEALTH", ALMATY, REPUBLIC OF KAZAKHSTAN
| | - Timur Utegaliev
- MANGYSTAU REGIONAL MULTIDISCIPLINARY HOSPITAL, AKTAU, REPUBLIC OF KAZAKHSTAN
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Chung-Lee L, Catallo C, Meade A. What are COVID-19 Patient Preferences for and Experiences with Virtual Care? Findings From a Scoping Review. J Patient Exp 2023; 10:23743735231215603. [PMID: 38026065 PMCID: PMC10664431 DOI: 10.1177/23743735231215603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Virtual care became a routine method for healthcare delivery during the coronavirus disease 2019 (COVID-19) pandemic. Patient preferences are central to delivering patient-centered and high-quality care. The pandemic challenged healthcare organizations and providers to quickly deliver safe healthcare to COVID-19 patients. This resulted in varied implementation of virtual healthcare services. With an increased focus on remote COVID-19 monitoring, little research has examined patient experiences with virtual care. This scoping review examined patient experiences and preferences with virtual care among community-based self-isolating COVID-19 patients. We identified a paucity of literature related to patient experiences and preferences regarding virtual care. Few articles focused on patient experiences and preferences as a primary outcome. Our research suggests that (1) patients view virtual care positively and to be feasible to use; (2) patient access to technology impacts patient satisfaction and experiences; and (3) to enhance the patient experience, healthcare organizations and providers need to support patient use of technology and resolve technology-related issues. When planning virtual care modalities, purposeful consideration of patient experiences and preferences is needed to deliver quality patient-centered care.
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Affiliation(s)
| | | | - Ava Meade
- Toronto Metropolitan University, Toronto, Canada
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10
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Belzile MN, Lam P, Chan AK, Andany N, Simor A, Estrada-Codecido J, Ga'al A, Kapsack A, Mahmud A, Fridman D, Lee SM, Santoro A, Vandenbergh N, Daneman N. Evaluating the impact of a virtual outpatient care program in preventing hospitalizations, emergency department visits and mortality for patients with COVID-19: a matched cohort study. Clin Microbiol Infect 2023:S1198-743X(23)00154-4. [PMID: 37059224 PMCID: PMC10091723 DOI: 10.1016/j.cmi.2023.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES We sought to evaluate the impact of virtual care in preventing unnecessary healthcare visits for SARSCoV-2 patients. METHODS We conducted a retrospective matched cohort study, evaluating the COVID-19 Expansion to Outpatients (COVIDEO) program involving virtual assessments for all positive patients in the Sunnybrook assessment center from January 2020 to June 2021, followed by risk-stratified routine follow-up, couriering of oxygen saturation devices, and 24 hour/day direct-to-physician pager for urgent questions. We linked COVIDEO data to province-wide datasets, matching each eligible COVIDEO patient to ≤10 other Ontario SARS-CoV-2 patients on age, sex, neighborhood, and date. The primary outcome was emergency department (ED) visit, hospitalization or death within 30 days. Multivariable regression accounted for comorbidities, vaccination and pre-pandemic healthcare utilization. RESULTS Among 6,508 eligible COVIDEO patients, 4,763 (73.1%) were matched to ≥1 non-COVIDEO patient. COVIDEO care was protective against the primary composite outcome (adjusted odds ratio (aOR) 0.91, 95%CI 0.82-1.02), with a reduction in ED visits (7.8% vs 9.6%; aOR 0.79, 95%CI 0.70-0.89), but increase in hospitalizations (3.8% vs 2.7%, aOR 1.37, 95%CI 1.14-1.63) reflecting more direct-to-ward admissions (1.3% vs 0.2%, p < 0.0001). Results were similar when matched comparators were limited to patients who had not received virtual care elsewhere with a decrease in ED visits (7.8 vs. 8.6%, aOR 0.86, 95%CI 0.75-0.99) and an increase in hospitalizations (3.7 vs 2.4%, aOR 1.45, 95%CI 1.17-1.80). CONCLUSIONS An intensive remote care program can prevent unnecessary ED visits and facilitate direct-to-ward hospitalizations and thereby mitigate the impact of COVID-19 on the healthcare system.
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Affiliation(s)
- Mei-Ni Belzile
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Philip Lam
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adrienne K Chan
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Andrew Simor
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jose Estrada-Codecido
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Amal Ga'al
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abby Kapsack
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Abdalla Mahmud
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Daniel Fridman
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Samantha M Lee
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada
| | - Aimee Santoro
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nancy Vandenbergh
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nick Daneman
- Faculty of Medicine, University of Toronto, Toronto, Canada; Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Canada.
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11
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Chung-Lee L, Catallo C. A new approach to digital health? Virtual COVID-19 care: A scoping review. Digit Health 2023; 9:20552076231152171. [PMID: 36798886 PMCID: PMC9926398 DOI: 10.1177/20552076231152171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
Aims The use of virtual care enabled by digital technologies has increased, prompted by public health restrictions in response to COVID-19. Non-hospitalized persons in the acute phase of COVID-19 illness may have unique health needs while self-isolating in the community. This scoping review aimed to explore the nature of care, the use of digital technologies, and patient outcomes arising from virtual care among community-based self-isolating COVID-19 patients. Methods Literature searches for peer-reviewed articles were conducted in four bibliographic databases: CINAHL, Medline, Embase and Cochrane Database of Systematic Reviews between January and February 2022, followed by hand-searching reference lists of included articles. Two levels of screening using defined eligibility criteria among two independent reviewers were completed. Results Of the 773 articles retrieved, 19 were included. Results indicate that virtual care can be safe while enabling timely detection of clinical deterioration to improve the illness trajectory. COVID-19 virtual care was delivered by single health professionals or by multidisciplinary teams using a range of low-technology methods such as telephone to higher technology methods like wearable technology that transmitted physiological data to the care teams for real-time or asynchronous monitoring. Conclusion The review described the varied nature of virtual care including its design, implementation, and evaluation. Further research is needed for continued exploration on how to leverage digital health assets for the delivery of appropriate and safe virtual COVID-19 community care, which can support patient recovery, control transmission, and prevent intensifying the burden on the health care system, especially during surges.
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Affiliation(s)
- Leinic Chung-Lee
- Faculty of Community Services, Toronto Metropolitan University (Formerly Ryerson University), Toronto, Canada
| | - Cristina Catallo
- Faculty of Community Services, Toronto Metropolitan University (Formerly Ryerson University), Toronto, Canada
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12
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Ganton J, Hubbard A, Kovacs Burns K. Patients with COVID-19 share their experiences of recovering at home following hospital care transitions and discharge preparation. Health Expect 2022; 25:2862-2875. [PMID: 36134451 PMCID: PMC9538741 DOI: 10.1111/hex.13595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Patients discharged following hospitalization for COVID-19 require clear discharge protocols, information resources and communications to adequately prepare them to safely and successfully transition from hospital to home. Our study focuses on the patients' transition to recovering at home including their hospital discharge preparation and hospital experiences. METHODS A qualitative descriptive study design involved interviewing patients who had been hospitalized for COVID-19 in one urban Alberta, Canada centre. Purposive sampling was used to select patients from a centralized COVID-19 hospital patient database stratified by month between March 2020 and February 2021. Other inclusion criteria (e.g., sex and age) were also considered. Semi-structured interviews with patients were recorded, transcribed and analysed using thematic analysis. Data sufficiency and saturation were determined. RESULTS Twelve patients shared their lived experiences and recovery journey from COVID-19. Themes were reported under three main areas as framed by the study aim-the current status of patients recovering at home, including the supports they used to manage; their discharge process and preparation to go home; and their various hospital-related experiences. Suggestions for improving aspects of the patient journey were also captured. CONCLUSION Findings provided details of the needs, information gaps and what matters most to patients when they are recovering from COVID-19 at home, including their preparation to safely and successfully transition from hospital to home (i.e., feeling well prepared to go home, including being adequately assessed and having clear discharge protocols and communication). Key learnings were applied to improve or develop patient discharge and transition resources. PATIENT OR PUBLIC CONTRIBUTION A patient/family advisor and patient experience partners were involved throughout the study, codeveloping all aspects, from the study design to the reporting and application of the findings. Leading into the study, patient experiences and feedback regarding the home from hospital recovery journey informed multiple aspects, including the codevelopment of the interview guide.
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Affiliation(s)
- Joanne Ganton
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada
| | - Amberley Hubbard
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada
| | - Katharina Kovacs Burns
- Alberta Health Services Primary Health Care, Edmonton, Alberta, Canada.,Cinical Quality Metrics Data & Analytics, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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13
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Estrada-Codecido J, Chan AK, Andany N, Lam PW, Nguyen M, Pinto R, Simor A, Daneman N. Prevalence and predictors of persistent post-COVID-19 symptoms. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2022; 7:208-219. [PMID: 36337595 PMCID: PMC9629726 DOI: 10.3138/jammi-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/27/2022] [Accepted: 06/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The pandemic has affected hundreds of millions of people; early reports suggesting high rates of prolonged symptoms may be prone to selection bias. METHODS In a program caring for all SARS-CoV-2 positive inpatients and outpatients between March to October 2020, and offering universal 90-day follow-up, we compared those who died prior to 90 days, not responding to follow-up, declining, or accepting follow-up. Among those seen or declining follow-up, we determined the prevalence and predictors of persistent symptoms. RESULTS Among 993 patients, 21 (2.1%) died prior to 90 days, 506 (50.9%) did not respond, 260 (26.1%) declined follow-up because they were well, and 206 (20.7%) were fully assessed. Of 466 who responded to follow-up inquiry, 133 (28.5%) reported ≥1 persistent symptom, including constitutional (15.5%), psychiatric (14.2%), rheumatologic (13.1%), neurologic (13.1%), cardiorespiratory (12.0%), and gastrointestinal (1.7%). Predictors differed for each symptom type. Any persistent symptom was more common in older patients (adjusted odds ratio [aOR] 1.11, 95% CI 1.04 to 1.18/5 years), those diagnosed in hospital (aOR 2.03, 95% CI 1.24 to 3.33) and those with initial constitutional and rheumatologic symptoms. Patients not responding to follow-up were younger and healthier at baseline. CONCLUSION Persistent symptoms are common and diverse 3 months post-COVID-19 but are likely over-estimated by most reports.
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Affiliation(s)
- Jose Estrada-Codecido
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Philip W Lam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Melody Nguyen
- Division of Physical Medicine & Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ruxandra Pinto
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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14
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Blöndal K, Sverrisdóttir SH, Hafberg A, Ragnarsdóttir ED, Ingadóttir B, Hafsteinsdóttir EJG, Zoëga S, Jónsdóttir H. Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic. J Adv Nurs 2022; 78:3782-3794. [PMID: 35975315 PMCID: PMC9538875 DOI: 10.1111/jan.15355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 06/14/2022] [Indexed: 12/01/2022]
Abstract
Aim To describe nursing surveillance of coronavirus disease 2019 (COVID‐19)‐infected patients through remote telephone calls and in an on‐site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. Design Qualitative descriptive study. Methods Data were collected through seven semi‐structured, audio‐recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. Results Nurses relied on intensive listening when assessing and caring for COVID‐19‐infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, ‘Confronting an unfamiliar health condition in unprecedented circumstances’ and the categories: ‘Digging into the unknown’ and ‘Ensuring holistic nursing care’. The category ‘Contributing to averting catastrophe’ reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. Conclusion Novel nursing surveillance through remote telephone calls and in an on‐site urgent care clinic delivered to COVID‐19 patients self‐managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. Impact Findings give a unique insight into nursing surveillance of COVID‐19‐infected patients provided through telephone calls and in on‐site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID‐19‐infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. Patient or Public Contribution There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.
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Affiliation(s)
- Katrín Blöndal
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Hafberg
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Brynja Ingadóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Sigríður Zoëga
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Helga Jónsdóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland.,Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland
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15
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Ganjali R, Jajroudi M, Kheirdoust A, Darroudi A, Alnattah A. Telemedicine solutions for clinical care delivery during COVID-19 pandemic: A scoping review. Front Public Health 2022; 10:937207. [PMID: 35937265 PMCID: PMC9354887 DOI: 10.3389/fpubh.2022.937207] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/24/2022] [Indexed: 01/04/2023] Open
Abstract
Background The unexpected emergence of coronavirus disease 2019 (COVID-19) has changed mindsets about the healthcare system and medical practice in many fields, forcing physicians to reconsider their approaches to healthcare provision. It is necessary to add new, unique, and efficient solutions to traditional methods to overcome this critical challenge. In this regard, telemedicine offers a solution to this problem. Remote medical activities could diminish unnecessary visits and provide prompt medical services in a timely manner. Objective This scoping review aimed to provide a map of the existing evidence on the use of telemedicine during the COVID-19 pandemic by focusing on delineation functions and technologies, analyzing settings, and identifying related outcomes. Methods This review was conducted following the Arksey and O'Malley framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed and Scopus databases were systematically searched based on specific eligibility criteria. The English publications included in this study focused on telemedicine systems implemented during the COVID-19 pandemic to provide clinical care services. Two independent reviewers screened the articles based on predefined inclusion and exclusion criteria. The relevant features of telemedicine systems were summarized and presented into the following four domains and their subcategories, including functionality, technology, context, and outcomes. Results Out of a total of 1,602 retrieved papers, 66 studies met the inclusion criteria. The most common function implemented was counseling, and telemedicine was used for diagnosis in seven studies. In addition, in 12 studies, tele-monitoring of patients was performed by phone, designed platforms, social media, Bluetooth, and video calls. Telemedicine systems were predominantly implemented synchronously (50 studies). Moreover, 10 studies used both synchronous and asynchronous technologies. Although most studies were performed in outpatient clinics or centers, three studies implemented a system for hospitalized patients, and four studies applied telemedicine for emergency care. Telemedicine was effective in improving 87.5% of health resource utilization outcomes, 85% of patient outcomes, and 100% of provider outcomes. Conclusion The benefits of using telemedicine in medical care delivery systems in pandemic conditions have been well-documented, especially for outpatient care. It could potentially improve patient, provider, and healthcare outcomes. This review suggests that telemedicine could support outpatient and emergency care in pandemic situations. However, further studies using interventional methods are required to increase the generalizability of the findings.
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Affiliation(s)
- Raheleh Ganjali
- Clinical Research Development Unit, Emam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdie Jajroudi
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Azam Kheirdoust
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Darroudi
- Department of Health Information Technology, Faculty of Paramedicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Ashraf Alnattah
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Jain S, Agarwal A, Bhardwaj A, Lakshmi PVM, Singh M, Chauhan A, Singh M. Remote Monitoring and Holistic Care of Home-Isolated COVID-19 Positive Healthcare Workers Through Digital Technology During the Omicron (B1.1.529) Wave: A Prospective Cohort Study From India. Front Public Health 2022; 10:936000. [PMID: 35910868 PMCID: PMC9326076 DOI: 10.3389/fpubh.2022.936000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BackgroundRemote monitoring through digital technology offers a promising solution for the diverse medical, psychological and social issues that plague patients with COVID-19 under home-isolation, but remain neglected due to a lack of streamlined medical services for these patients.MethodsThis prospective cohort study determined the feasibility of remote telemonitoring of healthcare workers with mild COVID-19 under home isolation during the Omicron (B1.1.529) wave and characterized their clinico-demographic profile. A holistic monitoring model comprising of mandatory phone calls at the beginning and end of isolation, assisted by home oximetry, predesigned google forms, and opt-in software-based (eSanjeevani OPD) teleconsultation was employed. Factors associated with development of symptomatic disease were also determined.ResultsOut of 100 COVID-19 positive healthcare workers under home-isolation, data for 94 participants was available [median age 27(20–52) years, 56(60%) females]. 93(99%) patients were previously vaccinated for COVID-19 (median time from last dose = 248 days); 34(36%) had a past history of COVID-19. Fever (67%), myalgia (69%), sore throat/dry cough (70%), and running nose (45%) were the most common symptoms. No patient progressed to moderate-severe disease or required care escalation during the remote monitoring period. Most participants reported several additional psychosocial concerns which were adequately addressed. Symptomatic patients had higher BMI (24.1 vs. 21.8kg/m2, p = 0.01) compared to asymptomatic patients. Age, past infection with COVID-19, and time since last vaccine dose were not different between symptomatic and asymptomatic patients.ConclusionCOVID-19 patients under home isolation have multi-faceted medical and psychosocial issues which can be holistically managed remotely through digital technology.
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Affiliation(s)
- Siddharth Jain
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amit Agarwal
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupriya Bhardwaj
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - PVM Lakshmi
- Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manvi Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anil Chauhan
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Meenu Singh
- Department of Telemedicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- *Correspondence: Meenu Singh
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17
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Cheng C, Manji K, Appel L, Smith C. Patient Experiences With a Remote Monitoring Pathway for COVID-19. Cureus 2022; 14:e26263. [PMID: 35911331 PMCID: PMC9313162 DOI: 10.7759/cureus.26263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: Due to the coronavirus disease 2019 (COVID-19) pandemic, a remote monitoring pathway was developed at Michael Garron Hospital to allow individuals with confirmed or presumed COVID-19 infection to successfully manage their illness at home. This study aims to understand patients’ experiences on this remote monitoring pathway and to investigate the effectiveness of the pathway in preventing unnecessary emergency department (ED) visits and detecting severe infection. Methods: A total of 35 semi-structured interviews were conducted over the phone. Researchers reviewed transcripts to come up with an index of nodes. Two researchers initially coded the same four transcripts to ensure high inter-rater reliability. The remaining 31 transcripts were coded by one researcher. Results: Of patients, 80% (n = 28) had a positive experience on the pathway. Remote monitoring was effective in reassuring 22.9% of patients (n = 8) with mild-moderate symptoms that their symptoms were not significant enough to go to the ED and they were monitored at home. A total of 8.6% of patients (n = 3) were correctly identified as having severe symptoms while on the pathway and were asked to present to the hospital. For 8.6% of patients (n = 3), remote monitoring did not identify their severe COVID-19 illness. Of patients, 2.9% (n = 1) were incorrectly identified as having severe COVID-19 symptoms when they were clinically well. Discussion: Remote monitoring is an effective tool to optimize healthcare resources during a pandemic. It reduces ER visits and provides a means for routine follow-up while minimizing virus exposure. Patients generally had a positive experience; however, more research needs to be done on optimizing the detection of severe infection.
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18
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Laur C, Agarwal P, Thai K, Kishimoto V, Kelly S, Liang K, Bhatia RS, Bhattacharyya O, Martin D, Mukerji G. Implementation and Evaluation of COVIDCare@Home, a Family Medicine Led Remote Monitoring Program for COVID-19 Patients: a multi-method cross-sectional study. JMIR Hum Factors 2022; 9:e35091. [PMID: 35499974 PMCID: PMC9239565 DOI: 10.2196/35091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams.
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Affiliation(s)
- Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Kelly Thai
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | - Vanessa Kishimoto
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA
| | | | | | - R Sacha Bhatia
- Population Health and Values Based Health Systems, Ontario Health, Toronto, CA.,Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Peter Munk Cardiac Centre, University Health Network, Toronto, CA
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care, University of Toronto, 76 Grenville Street, Toronto, CA.,Department of Family and Community Medicine, University of Toronto, Toronto, CA.,Women's College Hospital, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
| | - Geetha Mukerji
- Women's College Hospital, Toronto, CA.,Temerty Faculty of Medicine, University of Toronto, Toronto, CA.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, CA
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19
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Ward TJ, Mavilakandy A, Danns J, Tsaknis G, Reddy RV. Outcomes from a virtual ward delivering oxygen at home for patients recovering from COVID-19: a real world observational study. Clin Med (Lond) 2022; 22:197-202. [PMID: 38589080 DOI: 10.7861/clinmed.2021-0512] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a lack of data on the safety of providing oxygen at home to stable patients recovering from COVID-19. METHODS A retrospective analysis of patients discharged to a COVID-19 virtual ward (CVW) between January 2021 and March 2021 at a UK district general hospital was performed. Patients with improving clinical trajectories and oxygen requirements up to 4 L/minute were eligible. Outcomes measured were 30-day mortality and readmission rate. RESULTS From 02 January 2021 to 16 March 2021 (74 days), 147 patients discharged to the CVW were included: 71 received continuous or ambulatory oxygen, and 76 received pulse oximetry monitoring only. Five patients were readmitted within 30 days and two patients died. There were no significant differences between readmission and mortality rates between those discharged with or without oxygen. CONCLUSION Provision of oxygen at home for selected patients recovering from COVID-19 is safe with low risk of readmission and death.
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Affiliation(s)
- Thomas Jc Ward
- Kettering General Hospital NHS Foundation Trust, Kettering, UK and University of Leicester, Leicester, UK.
| | | | - Julie Danns
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
| | | | - Raja V Reddy
- Kettering General Hospital NHS Foundation Trust, Kettering, UK
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20
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Gray K, Chapman W, Khan UR, Borda A, Budge M, Dutch M, Hart GK, Gilbert C, Wani TA. The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services. JMIR Form Res 2022; 6:e32619. [PMID: 35297765 PMCID: PMC8993142 DOI: 10.2196/32619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 12/24/2021] [Accepted: 03/15/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. OBJECTIVE The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. METHODS A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. RESULTS The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. CONCLUSIONS These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings.
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Affiliation(s)
- Kathleen Gray
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Wendy Chapman
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Urooj R Khan
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Ann Borda
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | | | | | | | - Cecily Gilbert
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
| | - Tafheem Ahmad Wani
- Centre for Digital Transformation of Health, University of Melbourne, Melbourne, Australia
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21
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Ascencio-Montiel IDJ, Tomás-López JC, Álvarez-Medina V, Gil-Velázquez LE, Vega-Vega H, Vargas-Sánchez HR, Cervantes-Ocampo M, Villasís-Keever MÁ, González-Bonilla CR, Duque-Molina C. A Multimodal Strategy to Reduce the Risk of Hospitalization/death in Ambulatory Patients with COVID-19. Arch Med Res 2022; 53:323-328. [PMID: 35123809 PMCID: PMC8784438 DOI: 10.1016/j.arcmed.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 01/03/2022] [Accepted: 01/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Different interventions have been implemented worldwide for the house-hold monitoring of patients with mild COVID-19 to reduce the burden of healthcare systems and guarantee quality of care. Telephone follow up and treatment kits have not been evaluated in the context of a national-wide primary care program. AIM OF THE STUDY To compare the risk of hospitalization and death for COVID-19 between ambulatory patients who received and those who did not receive a treatment kit and telephone follow-up in a developing country METHODS: A two-group comparative analysis was conducted using data from the medical information systems of the Mexican Institute of Social Security. We included a total of 28,048 laboratory-confirmed SARS-CoV-2 patients: 7,898 (28.2%) received a medical kit and 20,150 (71.8%) did not. The incidence rates of hospitalization and death combined were calculated. To identify significant associations between hospitalization or death and treatment medical kits, we calculated the risk ratios using a multivariate logistic model. RESULTS The incidence of hospitalization was 6.14% in patients who received a kit and 11.71% in those who did not. Male sex, age, and a medical history of obesity, hypertension, diabetes, immunosuppression, or kidney disease were associated with increased risk of hospitalization or death. The risk rates were reduced in patients who received a medical kit or telephone follow-up. In the multivariate model, receiving a medical kit was associated with a lower risk of hospitalization or death from COVID-19: adjusted risk ratio 0.41 (95% confidence interval 0.36-0.47). CONCLUSION Use of a multimodal strategy may reduce the risk of hospitalization and death in adult outpatients with mild COVID-19.
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Affiliation(s)
- Iván de Jesús Ascencio-Montiel
- Coordinación de Vigilancia Epidemiológica, Unidad de Planeación e Innovación en Salud, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Juan Carlos Tomás-López
- División de Medicina Familiar, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Verónica Álvarez-Medina
- División de Medicina Familiar, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Luisa Estela Gil-Velázquez
- División de Medicina Familiar, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Hortensia Vega-Vega
- División de Medicina Familiar, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Héctor Raúl Vargas-Sánchez
- División de Medicina Familiar, Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Manuel Cervantes-Ocampo
- Coordinación de Unidades de Primer Nivel, Unidad de Atención Médica, Dirección de Prestaciones Médicas Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Miguel Ángel Villasís-Keever
- Unidad de Investigación en Análisis y Síntesis de la Evidencia, Coordinación de Investigación en Salud, Unidad de Educación e Investigación, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
| | - Cesar Raúl González-Bonilla
- Unidad de Investigación en Análisis y Síntesis de la Evidencia, Coordinación de Investigación en Salud, Unidad de Educación e Investigación, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México; Coordinación de Investigación en Salud, Unidad de Educación e Investigación, Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México.
| | - Célida Duque-Molina
- Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Ciudad de México, México
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22
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Lam PW, Andany N, Chan AK, Stroud L, Shadowitz S, Daneman N. Using Virtual Care to Facilitate Direct Hospital Admissions in Outpatients with Worsening COVID-19 Infection. Telemed J E Health 2022; 28:1704-1707. [PMID: 35363087 DOI: 10.1089/tmj.2021.0640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Recognizing emergency department overcrowding during the COVID-19 pandemic, a pathway to facilitate direct admissions for outpatients with worsening COVID-19 infection was created using the COVID-19 expansion to outpatients (COVIDEO) virtual care program. Outpatients appropriate for direct admission had oxygen saturations consistently <92% without severe respiratory distress. Pulse oximeters were proactively delivered to high-risk patients, and patients contacted the program in the event of worsening symptoms or desaturation persistently <92%. Over a 15-month period, 9,116 outpatients were managed by the program, 164 of whom were hospitalized, and 83 of those hospitalized (50.6%) were directly admitted through this pathway. Of those directly admitted, 10 (12.0%) patients required ICU admission, occurring a median of 4 days from hospital admission. The mortality rate among directly admitted patients was 3.6% (3/83). Implementation of a virtual care program to facilitate direct admissions in outpatients with COVID-19 created a safe, efficient, and patient-centered pathway of care.
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Affiliation(s)
- Philip W Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Nisha Andany
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Adrienne K Chan
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Lynfa Stroud
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Steven Shadowitz
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
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23
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Korycinski S, Metcalf D, Keteyian C. Effectiveness of a telephone-based nursing intervention to reduce hospital utilization by COVID-19 patients. Public Health Nurs 2022; 39:940-948. [PMID: 35334128 PMCID: PMC9115443 DOI: 10.1111/phn.13074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/27/2022] [Accepted: 03/03/2022] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Determine the effectiveness of a COVID-19 remote monitoring and management program in reducing preventable hospital utilization. DESIGN A retrospective cohort study utilizing data from electronic health records. SAMPLE Two hundred ninety-three patients who tested positive for COVID-19 at a drive-through testing site in Michigan. [Correction added on 11 April 2022, after first online publication: In the preceding sentence, "Two hundred and ninety-third" has been corrected to "Two hundred ninety-three" in this version.] The intervention group, consisting of 139 patients, was compared to a control group of 154 patients. MEASUREMENTS The primary outcome was the 30-day probability of hospital utilization. The covariates included in the analysis were age, gender, tobacco use, body mass index (BMI), race, and ethnicity. INTERVENTION A nurse-led, telephone-based active management protocol for COVID-19 patients who were isolating at home. RESULTS The intervention group had a non-statistically significant 42% reduction in risk of hospital utilization within 30 days of a positive COVID-19 test when compared to the control group (HR = 0.578, p-value .111, HR 95% CI [0.29, 1.13]). CONCLUSIONS A nurse-led remote monitoring and management program for COVID-19 reduced the probability of 30-day hospital utilization. Although the findings were not statistically significant, the program yielded practical significance by reducing hospital utilization, in-person interaction, and the risk of infection for healthcare workers.
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Affiliation(s)
- Samantha Korycinski
- Preventive Medicine Residency ProgramUniversity of Michigan School of Public HealthAnn ArborMichiganUSA
| | - David Metcalf
- Research StatisticianResearch and Support SystemsHenry Ford Allegiance HealthJacksonMichiganUSA
| | - Courtland Keteyian
- President/CEOJackson Health NetworkJacksonMichiganUSA,Vice PresidentPopulation HealthHenry Ford Allegiance HealthJacksonMichiganUSA,Medical DirectorOccupational HealthHenry Ford Allegiance HealthJacksonMichiganUSA
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24
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Jónsdóttir H, Sverrisdóttir SH, Hafberg A, Ómarsdóttir G, Ragnarsdóttir ED, Ingvarsdóttir S, Ingadóttir B, Hafsteinsdóttir EJG, Zoëga S, Blöndal K. "There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study. J Adv Nurs 2021; 78:1731-1742. [PMID: 34931713 PMCID: PMC9306803 DOI: 10.1111/jan.15131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 11/29/2022]
Abstract
Aim To provide insight into the contribution of nursing to the establishment and running of a hospital‐based outpatient clinic for COVID‐19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. Design Qualitative descriptive study centred on collaboration between nurse managers and researchers. Methods Drawing on Donabedian’s model of quality health services and the work of Allen on “Nurses’ organising work”, data were collected using four semi‐structured, audio‐recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub‐categories. Results “There was no panic – challenged by the unprecedented” was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub‐categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub‐categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers’ decision‐making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. Conclusion The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. Impact The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID‐19 and of healthcare development more generally.
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Affiliation(s)
- Helga Jónsdóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Anna Hafberg
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Geirný Ómarsdóttir
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | - Brynja Ingadóttir
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | | | - Sigríður Zoëga
- Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
| | - Katrín Blöndal
- Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
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25
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Zhabokritsky A, Daneman N, MacPhee S, Estrada-Codecido J, Santoro A, Kit Chan A, Wai-Hei Lam P, Simor A, Allen Leis J, Mubareka S, Andany N. Association between initial symptoms and subsequent hospitalization in outpatients with COVID-19: A cohort study. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:259-268. [PMID: 36338454 PMCID: PMC9629262 DOI: 10.3138/jammi-2021-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/20/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Most individuals with coronavirus disease 2019 (COVID-19) experience mild symptoms and are managed in the outpatient setting. The aim of this study was to determine whether self-reported symptoms at the time of diagnosis can identify patients at risk of clinical deterioration. METHODS This was a retrospective cohort study of 671 outpatients with laboratory-confirmed COVID-19 diagnosed in Toronto between March 1 and October 16, 2020. We examined the association between patients' baseline characteristics and self-reported symptoms at the time of diagnosis and the risk of subsequent hospitalization. RESULTS Of 671 participants, 26 (3.9%) required hospitalization. Individuals aged 65 years or older were more likely to require hospitalization (odds ratio [OR] 5.29, 95% CI 2.19 to 12.77), whereas those without medical comorbidities were unlikely to be hospitalized (OR 0.02, 95% CI 0.00 to 0.17). After adjusting for age and presence of comorbidities, sputum production (adjusted OR [aOR] 5.01, 95% CI 1.97 to 12.75), arthralgias (aOR 4.82, 95% CI 1.85 to 12.53), diarrhea (aOR 4.56, 95% CI 1.82 to 11.42), fever (aOR 3.64, 95% CI 1.50 to 8.82), chills (aOR 3.62, 95% CI 1.54 to 8.50), and fatigue (aOR 2.59, 95% CI 1.04 to 6.47) were associated with subsequent hospitalization. CONCLUSIONS Early assessment of symptoms among outpatients with COVID-19 can help identify individuals at risk of clinical deterioration. Additional studies are needed to determine whether more intense follow-up and early intervention among high-risk individuals can alter the clinical trajectory of and outcomes among outpatients with COVID-19.
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Affiliation(s)
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Scott MacPhee
- Department of Nursing, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jose Estrada-Codecido
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Aimee Santoro
- Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne Kit Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Philip Wai-Hei Lam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Simor
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jerome Allen Leis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samira Mubareka
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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26
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Baena-Díez JM, Gonzalez-Casafont I, Cordeiro-Coelho S, Fernández-González S, Rodríguez-Jorge M, Pérez-Torres CUF, Larrañaga-Cabrera A, García-Lareo M, de la Arada-Acebes A, Martín-Jiménez E, Pérez-Orcero A, Hernández-Ibáñez R, Gonzalo-Voltas A, Bermúdez-Chillida N, Simón-Muela C, del Carlo G, Bayona-Faro C, Rey-Reñones C, Aguilar-Palacio I, Grau M. Effectiveness of Telephone Monitoring in Primary Care to Detect Pneumonia and Associated Risk Factors in Patients with SARS-CoV-2. Healthcare (Basel) 2021; 9:healthcare9111548. [PMID: 34828594 PMCID: PMC8621826 DOI: 10.3390/healthcare9111548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/04/2021] [Accepted: 11/10/2021] [Indexed: 12/26/2022] Open
Abstract
Improved technology facilitates the acceptance of telemedicine. The aim was to analyze the effectiveness of telephone follow-up to detect severe SARS-CoV-2 cases that progressed to pneumonia. A prospective cohort study with 2-week telephone follow-up was carried out March 1 to May 4, 2020, in a primary healthcare center in Barcelona. Individuals aged ≥15 years with symptoms of SARS-CoV-2 were included. Outpatients with non-severe disease were called on days 2, 4, 7, 10 and 14 after diagnosis; patients with risk factors for pneumonia received daily calls through day 5 and then the regularly scheduled calls. Patients hospitalized due to pneumonia received calls on days 1, 3, 7 and 14 post-discharge. Of the 453 included patients, 435 (96%) were first attended to at a primary healthcare center. The 14-day follow-up was completed in 430 patients (99%), with 1798 calls performed. Of the 99 cases of pneumonia detected (incidence rate 20.8%), one-third appeared 7 to 10 days after onset of SARS-CoV-2 symptoms. Ten deaths due to pneumonia were recorded. Telephone follow-up by a primary healthcare center was effective to detect SARS-CoV-2 pneumonias and to monitor related complications. Thus, telephone appointments between a patient and their health care practitioner benefit both health outcomes and convenience.
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Affiliation(s)
- Jose Miguel Baena-Díez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), 08007 Barcelona, Spain;
- IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - Isabel Gonzalez-Casafont
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Sara Cordeiro-Coelho
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Soledad Fernández-González
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Migdalia Rodríguez-Jorge
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Clara Uxía Fernández Pérez-Torres
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Andrea Larrañaga-Cabrera
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Manel García-Lareo
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Ana de la Arada-Acebes
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Esther Martín-Jiménez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Almudena Pérez-Orcero
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Rosario Hernández-Ibáñez
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Ana Gonzalo-Voltas
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Noemí Bermúdez-Chillida
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Consuelo Simón-Muela
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Guillermo del Carlo
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Carolina Bayona-Faro
- La Marina Primary Care Center, Catalan Institute of Health (ICS), 08038 Barcelona, Spain; (J.M.B.-D.); (I.G.-C.); (S.C.-C.); (S.F.-G.); (M.R.-J.); (C.U.F.P.-T.); (A.L.-C.); (M.G.-L.); (A.d.l.A.-A.); (E.M.-J.); (A.P.-O.); (R.H.-I.); (A.G.-V.); (N.B.-C.); (C.S.-M.); (G.d.C.); (C.B.-F.)
| | - Cristina Rey-Reñones
- IDIAP Jordi Gol, Catalan Institute of Health (ICS), 08007 Barcelona, Spain;
- Unit of Research Support Camp de Tarragona, Catalan Institute of Health (ICS), 43202 Tarragona, Spain
| | - Isabel Aguilar-Palacio
- Research Group in Health Services of Aragon, (GRISSA) IIS Aragón, University of Zaragoza, 50009 Zaragoza, Spain;
| | - María Grau
- IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
- Serra Húnter Fellow, Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
- Biomedical Research Consortium in Epidemiology and Public Health (CIBERESP), 08003 Barcelona, Spain
- Correspondence:
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Rocha-Haro A, Morgenstern-Kaplan D, Canales-Albarrán SJ, Nuñez-García E, León-Mayorga Y. The Coronaid Program: An App-Based Telemedicine Tool for Triaging, Testing, Treating and Monitoring COVID-19 Patients in Mexico. Cureus 2021; 13:e19920. [PMID: 34976522 PMCID: PMC8712231 DOI: 10.7759/cureus.19920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To describe the results of a Mexican telemedicine program for patients with coronavirus disease 2019 (COVID-19). METHODS An observational retrospective study was conducted to analyze and describe the baseline demographic and clinical characteristics of patients who received medical video consultations for respiratory symptoms. RESULTS A total of 1,148 video consultations were given from March to September 2020 via Sofía's mobile app. A total of 580 patients sought medical consultation regarding respiratory symptoms. Of the patients, 51% were male and the mean age was 36 years (SD = 13). Of the patients, 35% had comorbidities such as diabetes, hypertension, and obesity, and 1.2% were sent to the ED. Fifty-seven polymerase chain reaction (PCR) tests for COVID-19 were requested and we detected a 53% positivity rate with a mean follow-up of 4.6 consultations. CONCLUSION Telemedicine has proven to be a safe and effective tool for triaging, testing, treating, and remote monitoring of patients with mild COVID-19. Patients triaged by Sofía had good overall outcomes and reduced the risks of in-person consultation in the pandemic.
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Zulfiqar AA, Massimbo DND, Hajjam M, Geny B, Talha S, Hajjam J, Erve S, Hajjam A, Andrès E. Results of the Second Phase of the GER-e-TEC Experiment concerning the Telemonitoring of Elderly Patients Affected by COVID-19 Disease to Detect the Exacerbation of Geriatric Syndromes. J Pers Med 2021; 11:1117. [PMID: 34834469 PMCID: PMC8621367 DOI: 10.3390/jpm11111117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has wreaked health and economic damage globally. This pandemic has created a difficult challenge for global public health. The coronavirus disease 2019 (COVID-19) pandemic has necessitated the use of new technologies and new processes to care for hospitalized patients, including elderly patients. Our team developed a telemonitoring program focused on the prevention of geriatric syndromes, the "GER-e-TEC COVID study". METHODS This second phase took place during the 3rd wave of the epidemic in France, between 14 December 2020 and 25 February 2021, conducted in the University Hospital of Strasbourg. RESULTS 30 elderly patients affected by COVID-19 disease were monitored remotely; the mean age was 85.9 years and a male/female ratio of 1.5 to 1.11 (36.7%) died during the experiment. The patients used the telemedicine solution for an average of 27.3 days. 140,260 measurements were taken while monitoring the geriatric syndromes of the entire patient group. 4675 measurements were recorded per patient for geriatric disorders and risks. 319 measurements were recorded per patient per day. The telemedicine solution emitted a total of 1245 alerts while monitoring the geriatric syndromes of the entire patient group. In terms of sensitivity, the results were 100% for all geriatric risks and extremely satisfactory in terms of positive and negative predictive values. Survival analyses showed that gender played no role in the length of the hospital stay, regardless of the reason for the hospitalization (decompensated heart failure (p = 0.45), deterioration of general condition (p = 0.12), but significant for death (p = 0.028)). The analyses revealed that the length of the hospital stay was not affected by the number of alerts. The results concerning the predictive nature of alerts are satisfactory. CONCLUSIONS The MyPredi™ telemedicine system allows for the generation of automatic, non-intrusive alerts when the health of a COVID-19 elderly patient deteriorates due to risks associated with geriatric syndromes.
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Affiliation(s)
- Abrar-Ahmad Zulfiqar
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France;
| | | | - Mohamed Hajjam
- Predimed Technology Society, 67300 Schiltigheim, France; (D.N.D.M.); (M.H.)
| | - Bernard Geny
- Service de Physiologie et d’Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France; (B.G.); (S.T.)
| | - Samy Talha
- Service de Physiologie et d’Explorations Fonctionnelles, Hôpitaux Universitaires de Strasbourg, Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France; (B.G.); (S.T.)
| | - Jawad Hajjam
- Centre d’Expertise des TIC pour l’Autonomie (CenTich), Mutualité Française Anjou-Mayenne (MFAM)-Angers, 49000 Angers, France; (J.H.); (S.E.)
| | - Sylvie Erve
- Centre d’Expertise des TIC pour l’Autonomie (CenTich), Mutualité Française Anjou-Mayenne (MFAM)-Angers, 49000 Angers, France; (J.H.); (S.E.)
| | - Amir Hajjam
- Laboratoire IRTES-SeT, Université de Technologie de Belfort-Montbéliard (UTBM), Belfort-Montbéliard, 90000 Belfort, France;
| | - Emmanuel Andrès
- Service de Médecine Interne, Diabète et Maladies Métaboliques de la Clinique Médicale B, Hôpitaux Universitaires de Strasbourg, Equipe EA 3072 “Mitochondrie, Stress Oxydant et Protection Musculaire”, Faculté de Médecine, Université de Strasbourg, 67000 Strasbourg, France;
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Survey of Telemedicine by Pediatric Nephrologists During the COVID-19 Pandemic. Kidney Int Rep 2021; 6:2316-2322. [PMID: 34514192 PMCID: PMC8419113 DOI: 10.1016/j.ekir.2021.06.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction The slow increase in use of telemedicine began to expand rapidly, along with reimbursement changes, during the coronavirus disease-2019 (COVID-19) pandemic. Standardized protocols for these services are lacking but are needed for effective and equitable health care. In this study, we queried pediatric nephrologists and their patients about their telemedicine experiences during the pandemic. Methods Surveys that were in compliance with the Health Insurance Portability and Accountability Act were deployed online to patients and physicians. Results We collected survey responses from 400 patients and 197 pediatric nephrologists. Patients reported positive experiences with telemedicine visits as it was logistically easier than in-person visits. Patients also felt that the quality of their visits were equivalent to what they would receive in person. Physicians used a wide variety of online systems to conduct synchronous telemedicine with Zoom (23%), EPIC (9%), Doxy.me (7%), services not specified (37%), or a mix of local or smaller services (24%). Most physicians' concerns were related to technological issues and the ability to procure physical exams and/or laboratory results. Conclusions There is a paucity of published trials on telemedicine services in pediatric nephrology. Virtual care was feasible and acceptable for patients, caregivers, and providers during the COVID-19 pandemic.
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Abd-Alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review. J Med Internet Res 2021; 23:e29136. [PMID: 34406962 PMCID: PMC8767979 DOI: 10.2196/29136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 06/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. OBJECTIVE This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. METHODS We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. RESULTS Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). CONCLUSIONS Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Asmaa Hassan
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Israa Abuelezz
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Arfan Ahmed
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Mahmood Saleh Alzubaidi
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Uzair Shah
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Anna Giannicchi
- School of Professional Studies, Berkeley College, New York, NY, United States
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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Valdivia G, Schmidt A, Schmidt B, Rivera F, Oñate A, Navarrete C, Campos J, Labarca G. Association between cardiovascular mortality and STOP-Bang questionnaire scores in a cohort of hospitalized patients: a prospective study. J Bras Pneumol 2021; 47:e20210039. [PMID: 34495174 PMCID: PMC8979666 DOI: 10.36416/1806-3756/e20210039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/09/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Obstructive sleep apnea (OSA) is associated with an increased risk of mortality and cardiometabolic diseases. The STOP-Bang questionnaire is a tool to screen populations at risk of OSA and prioritize complementary studies. Our objective was to evaluate the clinical utility of this questionnaire in identifying patients at an increased risk of mortality after discharge in a cohort of hospitalized patients. METHODS This was a prospective cohort study involving consecutive patients admitted to an internal medicine unit between May and June of 2017 who were reevaluated three years after discharge. At baseline, we collected data on comorbidities (hypertension, obesity, diabetes, and fasting lipid profile) and calculated STOP-Bang scores, defining the risk of OSA (0-2 score, no risk; ≥ 3 score, risk of OSA; and ≥ 5 score, risk of moderate-to-severe OSA), which determined the study groups. We also recorded data regarding all-cause and cardiovascular mortality at the end of the follow-up period. RESULTS The sample comprised 435 patients. Of those, 352 (80.9%) and 182 (41.8%) had STOP-Bang scores ≥ 3 and ≥ 5, respectively. When compared with the group with STOP-Bang scores of 0-2, the two groups showed higher prevalences of obesity, hypertension, diabetes, and dyslipidemia. Multivariate analysis showed an independent association between cardiovascular mortality and STOP-Bang score ≥ 5 (adjusted hazard ratio = 3.12 [95% CI, 1.39-7.03]; p = 0.01). Additionally, previous coronary heart disease was also associated with cardiovascular mortality. CONCLUSIONS In this cohort of hospitalized patients, STOP-Bang scores ≥ 5 were able to identify patients at an increased risk of cardiovascular mortality three years after discharge.
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Affiliation(s)
- Gabriel Valdivia
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile
| | - Alexia Schmidt
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile
| | - Bettina Schmidt
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile
| | - Francisca Rivera
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile
| | - Aileen Oñate
- . Facultad de Medicina, Universidad San Sebastian, Los Ángeles, Chile
| | - Camila Navarrete
- . Facultad de Medicina, Universidad San Sebastian, Los Ángeles, Chile
| | - Josue Campos
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile
| | - Gonzalo Labarca
- . Facultad de Medicina, Universidad de Concepción, Los Ángeles, Chile.,. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston (MA) USA
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Simian D, Martínez M, Dreyse J, Chomali M, Retamal M, Labarca G. Clinical characteristics and predictors of hospitalization among 7,108 ambulatory patients with positive RT-PCR for SARS-CoV-2 during the acute pandemic period. J Bras Pneumol 2021; 47:e20210131. [PMID: 34495176 PMCID: PMC8979667 DOI: 10.36416/1806-3756/e20210131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 05/25/2021] [Indexed: 01/08/2023] Open
Abstract
Objective: To describe baseline characteristics of outpatients with a positive RT-PCR for SARS-CoV-2 and to define whether “red flags” (new-onset fever, dyspnea, and chest pain) can predict clinical worsening during the isolation period. Methods: This was an epidemiological, observational, descriptive study. Between March and September of 2020, all outpatients who tested positive for SARS-CoV-2 at a tertiary medical center located in Santiago de Chile were included. Demographic variables, comorbidities, red flags, and other symptoms were compiled using follow-up surveys at specific time points. The risk of clinical worsening (hospitalization) and adjusted hazard ratios (HRs) were calculated. Results: A total of 7,108 patients were included. The median age was 38 years (range, 0-101), and 52% were men. At baseline, 77% of the patients reported having characteristic symptoms of SARS-CoV-2 infection. The most prevalent onset symptoms were headache (53%), myalgia (47%), and fever (33%). According to the follow-up surveys, the incidence of symptoms decreased during the isolation period; however, 28% of the patients still presented with symptoms on day 14. The risk of hospitalization for patients with new-onset fever and dyspnea during the follow-up period was HR = 7.43 (95% CI, 3.85-14.3, p<0.01) and HR = 5.27 (95% CI, 1.52-18.30; p < 0.01 for both), respectively. New-onset chest pain showed no association with clinical worsening. Conclusions: In this sample of outpatients with a recent diagnosis of SARS-CoV-2 infection, a survey-based monitoring of symptoms was useful to identify those at risk of clinical worsening. New-onset fever and dyspnea during the isolation period were considered as red flags associated with clinical worsening and warrants prompt medical evaluation.
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Affiliation(s)
- Daniela Simian
- . Subdirección de Investigación, Dirección Académica, Clínica Las Condes, Santiago, Chile
| | - Maripaz Martínez
- . Subdirección de Investigación, Dirección Académica, Clínica Las Condes, Santiago, Chile
| | - Jorge Dreyse
- . Centro de Enfermedades Respiratorias y Cirugía de Tórax, Clínica Las Condes, Santiago, Chile
| | - May Chomali
- . Comité de COVID-19, Clínica Las Condes, Santiago, Chile
| | - Marcelo Retamal
- . Departamento de Tecnología de la Información, Clínica Las Condes, Santiago, Chile
| | - Gonzalo Labarca
- . Departamento de Medicina Interna, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.,. Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston (MA) USA
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Genis H, MacPhee S, Vandenbergh N, Yu C, Andany N, Chan AK, Daneman N, Lam PW. Ontario COVID-19 assessment centre practices in patient counselling, education, and follow-up care: A provincial survey. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:198-204. [PMID: 36337759 PMCID: PMC9615467 DOI: 10.3138/jammi-2020-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/03/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND In March 2020, COVID-19 assessment centres were launched across the province of Ontario to facilitate COVID-19 testing outside of emergency departments. We aimed to study the degree to which assessment centres provide education and follow-up care for patients with suspected COVID-19. METHODS We conducted an online survey of Ontario COVID-19 assessment centre directors between September 15 and October 15, 2020. The primary outcomes studied were the types of educational modalities employed and information conveyed, methods and frequency of test result communication, and any follow-up care that was offered. Survey respondents were also asked to provide descriptions of barriers to patient education and test communication. RESULTS A total of 56 directors (representing 73 assessment centres) completed the survey. The most frequent educational modalities employed were educational handouts (92%), direct in-person counselling (89%), and referral to website (72%). Seventy-one percent of respondents indicated patients with positive test results would be notified, and 61% of respondents indicated that follow-up care would be offered. The most frequently reported barriers to patient education were insufficient time and high volume of tests, while the most frequently reported barriers to communication of test results were difficulty accessing online health portals and high volume of tests. CONCLUSION The ability of many assessment centres to provide patient education is limited by both individual patient and system-level factors. Assessment centres may benefit from standardization of educational materials, improved accessibility to test results for patients in marginalized groups, and virtual pathways to facilitate additional counselling and care for individuals who test positive.
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Affiliation(s)
- Helen Genis
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Scott MacPhee
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Chris Yu
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nisha Andany
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Philip W Lam
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Tilahun B, Gashu KD, Mekonnen ZA, Endehabtu BF, Angaw DA. Mapping the Role of Digital Health Technologies in Prevention and Control of COVID-19 Pandemic: Review of the Literature. Yearb Med Inform 2021; 30:26-37. [PMID: 34479378 PMCID: PMC8416203 DOI: 10.1055/s-0041-1726505] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Coronavirus Disease (COVID-19) is currently spreading exponentially around the globe. Various digital health technologies are currently being used as weapons in the fight against the pandemic in different ways by countries. The main objective of this review is to explore the role of digital health technologies in the fight against the COVID-19 pandemic and address the gaps in the use of these technologies for tackling the pandemic. METHODS We conducted a scoping review guided by the Joanna Briggs Institute guidelines. The articles were searched using electronic databases including MEDLINE (PubMed), Cochrane Library, and Hinari. In addition, Google and Google scholar were searched. Studies that focused on the application of digital health technologies on COVID-19 prevention and control were included in the review. We characterized the distribution of technological applications based on geographical locations, approaches to apply digital health technologies and main findings. The study findings from the existing literature were presented using thematic content analysis. RESULTS A total of 2,601 potentially relevant studies were generated from the initial search and 22 studies were included in the final review. The review found that telemedicine was used most frequently, followed by electronic health records and other digital technologies such as artificial intelligence, big data, and the internet of things (IoT). Digital health technologies were used in multiple ways in response to the COVID-19 pandemic, including screening and management of patients, methods to minimize exposure, modelling of disease spread, and supporting overworked providers. CONCLUSION Digital health technologies like telehealth, mHealth, electronic medical records, artificial intelligence, the internet of things, and big data/internet were used in different ways for the prevention and control of the COVID-19 pandemic in different settings using multiple approaches. For more effective deployment of digital health tools in times of pandemics, development of a guiding policy and standard on the development, deployment, and use of digital health tools in response to a pandemic is recommended.
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Affiliation(s)
- Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Dessie Gashu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zeleke Abebaw Mekonnen
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Health System Directorate, Ministry of Health, Ethiopia
| | - Berhanu Fikadie Endehabtu
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dessie Abebaw Angaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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A Clinical Monitoring Program of COVID-19 Outpatients: A Prospective Cohort Study. ACTA ACUST UNITED AC 2021; 2021:6644570. [PMID: 34336065 PMCID: PMC8292082 DOI: 10.1155/2021/6644570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/05/2021] [Indexed: 01/08/2023]
Abstract
Purpose Coronavirus disease 2019 (COVID-19) has been associated with a high rate of mortality and morbidity. While a high portion of COVID-19 patients have mild symptoms, a limited number of clinical trials have evaluated the clinical course of this large group of patients. This study was designed to investigate the demographics and clinical characteristics and comorbidity of nonhospitalized COVID-19 patients. Methods This prospective, observational cohort study was performed on nonhospitalized adult patients (≥18 years) with COVID-19. Pharmacotherapy service was responsible for patients' assessment for up to 1 month. Demographic characteristics, the onset of symptoms, severity, duration, laboratory data, and hospitalization rate were evaluated by a pharmacist-based monitoring program. Results From 323 patients who had been referred to the emergency department, 105 individuals were recruited between April 26 and August 2, 2020. Most of the patients were female (66.7%) with a mean age of 39.39 years (SD: ± 15.82). The mean time of the symptom onset was 5.6 days (SD: ±1.79). The majority of patients suffered from fatigue (78.1%), sore throat (67.6%), cough (60%), and myalgia (55.2%). C-reactive protein, white blood cell, lymphocyte, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and hemoglobin levels were recovered significantly during the first two weeks (P < 0.001). Hydroxychloroquine, naproxen, diphenhydramine, azithromycin, and vitamin D3 were the most common medications administered (98%, 96%, 94%, 68%, and 57%, respectively). Forty patients were not symptom-free after the one-month follow-up, and 8 patients (7.6%) were required to revisit without the need for hospitalization. Anosmia (18.1%) and fatigue (17.1%) were the most common persisted symptoms. There were no significant differences between symptom-free and symptomatic patients. Conclusion Mild COVID-19 patients had a wide variety of symptoms and could be symptomatic even one month after the onset of symptoms. The pharmacist-based monitoring system can contribute beneficially to patients through the evaluation of symptoms, reduction of unnecessary visits, and provision of updated information to patients concerning the status of their illness.
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Khoshrounejad F, Hamednia M, Mehrjerd A, Pichaghsaz S, Jamalirad H, Sargolzaei M, Hoseini B, Aalaei S. Telehealth-Based Services During the COVID-19 Pandemic: A Systematic Review of Features and Challenges. Front Public Health 2021; 9:711762. [PMID: 34350154 PMCID: PMC8326459 DOI: 10.3389/fpubh.2021.711762] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/21/2021] [Indexed: 01/11/2023] Open
Abstract
Background: As an ever-growing popular service, telehealth catered for better access to high-quality healthcare services. It is more valuable and cost-effective, particularly in the middle of the current COVID-19 pandemic. Accordingly, this study aimed to systematically review the features and challenges of telehealth-based services developed to support COVID-19 patients and healthcare providers. Methods: A comprehensive search was done for the English language and peer-reviewed articles published until November 2020 using PubMed and Scopus electronic databases. In this review paper, only studies focusing on the telehealth-based service to support COVID-19 patients and healthcare providers were included. The first author's name, publication year, country of the research, study objectives, outcomes, function type including screening, triage, prevention, diagnosis, treatment or follow-up, target population, media, communication type, guideline-based design, main findings, and challenges were extracted, classified, and tabulated. Results: Of the 5,005 studies identified initially, 64 met the eligibility criteria. The studies came from 18 countries. Most of them were conducted in the United States and China. Phone calls, mobile applications, videoconferencing or video calls, emails, websites, text messages, mixed-reality, and teleradiology software were used as the media for communication. The majority of studies used a synchronous communication. The articles addressed the prevention, screening, triage, diagnosis, treatment, and follow-up aspects of COVID-19 which the most common purpose was the patients' follow-up (34/64, 53%). Thirteen group barriers were identified in the literature, which technology acceptance and user adoption, concerns about the adequacy and accuracy of subjective patient assessment, and technical issues were the most frequent ones. Conclusion: This review revealed the usefulness of telehealth-based services during the COVID-19 outbreak and beyond. The features and challenges identified through the literature can be helpful for a better understanding of current telehealth approaches and pointed out the need for clear guidelines, scientific evidence, and innovative policies to implement successful telehealth projects.
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Affiliation(s)
- Farnaz Khoshrounejad
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahsa Hamednia
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ameneh Mehrjerd
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shima Pichaghsaz
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Jamalirad
- Department of Computer Engineering, Ayatollah Amoli University, Science and Research Branch, Amol, Iran
| | - Mahdi Sargolzaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Benyamin Hoseini
- Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Shokoufeh Aalaei
- Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Vindrola-Padros C, Singh KE, Sidhu MS, Georghiou T, Sherlaw-Johnson C, Tomini SM, Inada-Kim M, Kirkham K, Streetly A, Cohen N, Fulop NJ. Remote home monitoring (virtual wards) for confirmed or suspected COVID-19 patients: a rapid systematic review. EClinicalMedicine 2021; 37:100965. [PMID: 34179736 PMCID: PMC8219406 DOI: 10.1016/j.eclinm.2021.100965] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND the aim of this review was to analyze the implementation and impact of remote home monitoring models (virtual wards) for confirmed or suspected COVID-19 patients, identifying their main components, processes of implementation, target patient populations, impact on outcomes, costs and lessons learnt. METHODS we carried out a rapid systematic review on models led by primary and secondary care across seven countries (US, Australia, Canada, The Netherlands, Ireland, China, UK). The main outcomes included in the review were: impact of remote home monitoring on virtual length of stay, escalation, emergency department attendance/reattendance, admission/readmission and mortality. The search was updated on February 2021. We used the PRISMA statement and the review was registered on PROSPERO (CRD: 42020202888). FINDINGS the review included 27 articles. The aim of the models was to maintain patients safe in the appropriate setting. Most models were led by secondary care and confirmation of COVID-19 was not required (in most cases). Monitoring was carried via online platforms, paper-based systems with telephone calls or (less frequently) through wearable sensors. Models based on phone calls were considered more inclusive. Patient/career training was identified as a determining factor of success. We could not reach substantive conclusions regarding patient safety and the identification of early deterioration due to lack of standardized reporting and missing data. Economic analysis was not reported for most of the models and did not go beyond reporting resources used and the amount spent per patient monitored. INTERPRETATION future research should focus on staff and patient experiences of care and inequalities in patients' access to care. Attention needs to be paid to the cost-effectiveness of the models and their sustainability, evaluation of their impact on patient outcomes by using comparators, and the use of risk-stratification tools.
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Affiliation(s)
- Cecilia Vindrola-Padros
- Department of Targeted Intervention, University College London (UCL), Charles Bell House, 43-45 Foley Street, London W1W 7TY, United Kingdom
| | - Kelly E Singh
- Health Services Management Centre, School of Social Policy, University of Birmingham, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Manbinder S Sidhu
- Health Services Management Centre, School of Social Policy, University of Birmingham, Park House, University of Birmingham, Edgbaston, Birmingham B15 2RT, UK
| | - Theo Georghiou
- Nuffield Trust, 59 New Cavendish Street, London W1G 7LP, UK
| | | | - Sonila M Tomini
- Department of Applied Health Research, University College London, Gower Street London, WC1E 6BT, UK
| | - Matthew Inada-Kim
- Wessex Academic Health and Science Network, National COVID Clinical Reference groups- Primary care, Secondary care, Care homes, National Clinical Lead Deterioration and National Specialist Advisor Sepsis, NHS England and NHS Improvement, McGill ward, Royal Hampshire County Hospital, Romsey Road, Winchester SO21 1QW, UK
| | - Karen Kirkham
- Integrated Care System Clinical Lead, NHSE/I Senior Medical Advisor Primary Care Transformation, Dorset CCG, Vespasian House, Barrack Rd, Dorchester DT1 7TG, UK
| | - Allison Streetly
- Department of Population Health Sciences Faculty of Life Sciences and Medicine King's College London SE1 1UL, UK
- Deputy National Lead Healthcare Public Health, Public Health England133-155 Waterloo Rd, London SE1 8UG, UK
| | | | - Naomi J Fulop
- Department of Applied Health Research, University College London, Gower Street London, WC1E 6BT, UK
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Pezzutti DL, Wadhwa V, Makary MS. COVID-19 imaging: Diagnostic approaches, challenges, and evolving advances. World J Radiol 2021; 13:171-191. [PMID: 34249238 PMCID: PMC8245752 DOI: 10.4329/wjr.v13.i6.171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 05/15/2021] [Accepted: 06/23/2021] [Indexed: 02/06/2023] Open
Abstract
The role of radiology and the radiologist have evolved throughout the coronavirus disease-2019 (COVID-19) pandemic. Early on, chest computed tomography was used for screening and diagnosis of COVID-19; however, it is now indicated for high-risk patients, those with severe disease, or in areas where polymerase chain reaction testing is sparsely available. Chest radiography is now utilized mainly for monitoring disease progression in hospitalized patients showing signs of worsening clinical status. Additionally, many challenges at the operational level have been overcome within the field of radiology throughout the COVID-19 pandemic. The use of teleradiology and virtual care clinics greatly enhanced our ability to socially distance and both are likely to remain important mediums for diagnostic imaging delivery and patient care. Opportunities to better utilize of imaging for detection of extrapulmonary manifestations and complications of COVID-19 disease will continue to arise as a more detailed understanding of the pathophysiology of the virus continues to be uncovered and identification of predisposing risk factors for complication development continue to be better understood. Furthermore, unidentified advancements in areas such as standardized imaging reporting, point-of-care ultrasound, and artificial intelligence offer exciting discovery pathways that will inevitably lead to improved care for patients with COVID-19.
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Affiliation(s)
- Dante L Pezzutti
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
| | - Vibhor Wadhwa
- Department of Radiology, Weill Cornell Medical Center, New York City, NY 10065, United States
| | - Mina S Makary
- Department of Radiology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, United States
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Blair JE, Gotimukul A, Wang F, Mina SA, Bartels HC, Burns MW, Kole AE, Vikram HR, Gea-Banacloche JC, Seville MT, Petty SAB, Vikram A, Orenstein R. Mild to moderate COVID-19 illness in adult outpatients: Characteristics, symptoms, and outcomes in the first 4 weeks of illness. Medicine (Baltimore) 2021; 100:e26371. [PMID: 34128896 PMCID: PMC8213280 DOI: 10.1097/md.0000000000026371] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/26/2021] [Indexed: 01/04/2023] Open
Abstract
Most patients with coronavirus disease 2019 (COVID-19) have mild to moderate illness not requiring hospitalization. However, no study has detailed the evolution of symptoms in the first month of illness.At our institution, we conducted remote (telephone and video) visits for all adult outpatients diagnosed with COVID-19 within 24 h of a positive nasopharyngeal polymerase chain test for SARS-CoV-2. We repeated regular video visits at 7, 14, and 28 days after the positive test, retrospectively reviewed the prospective data collected in the remote visits, and constructed a week by week profile of clinical illness, through week 4 of illness.We reviewed the courses of 458 symptomatic patients diagnosed between March 12, 2020, and June 22, 2020, and characterized their weekly courses. Common initial symptoms included fever, headache, cough, and chest pain, which frequently persisted through week 3 or longer. Upper respiratory or gastrointestinal symptoms were much shorter lived, present primarily in week 1. Anosmia/ageusia peaked in weeks 2 to 3. Emergency department visits were frequent, with 128 visits in the 423 patients who were not hospitalized and 48 visits among the 35 outpatients (7.6%) who were eventually hospitalized (2 subsequently died). By the fourth week, 28.9% said their illness had completely resolved. After the 4-week follow up, 20 (4.7%) of the 423 nonhospitalized patients had further medical evaluation and management for subacute or chronic COVID-19 symptoms.Mild to moderate outpatient COVID-19 is a prolonged illness, with evolving symptoms commonly lasting into the fourth week of illness.
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Affiliation(s)
| | - Ashwini Gotimukul
- Division of Infectious Diseases
- Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
| | - Fangfang Wang
- Department of Internal Medicine, Mayo Clinic Hospital, Phoenix
| | - Syeda A. Mina
- Department of Internal Medicine, Mayo Clinic Hospital, Phoenix
| | | | | | | | | | - Juan C. Gea-Banacloche
- Division of Infectious Diseases
- Division of Clinical Research, National Institutes of Allergy and Infectious Diseases, Bethesda, Maryland, U.S.A
| | | | | | - Avinash Vikram
- Division of Infectious Diseases
- Division of Infectious Diseases, University of Louisville, Louisville, Kentucky
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O'Keefe JB, Tong EJ, Taylor TH, O'Keefe GAD, Tong DC. Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients With COVID-19: Retrospective Analysis. JMIR Public Health Surveill 2021; 7:e25075. [PMID: 33667174 PMCID: PMC8092025 DOI: 10.2196/25075] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background Risk assessment of patients with acute COVID-19 in a telemedicine context is not well described. In settings of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum health care and public health benefit. Objective The goal of this study was to determine whether a COVID-19 telemedicine risk assessment tool accurately predicts hospitalizations. Methods We conducted a retrospective study of a COVID-19 telemedicine home monitoring program serving health care workers and the community in Atlanta, Georgia, with enrollment from March 24 to May 26, 2020; the final call range was from March 27 to June 19, 2020. All patients were assessed by medical providers using an institutional COVID-19 risk assessment tool designating patients as Tier 1 (low risk for hospitalization), Tier 2 (intermediate risk for hospitalization), or Tier 3 (high risk for hospitalization). Patients were followed with regular telephone calls to an endpoint of improvement or hospitalization. Using survival analysis by Cox regression with days to hospitalization as the metric, we analyzed the performance of the risk tiers and explored individual patient factors associated with risk of hospitalization. Results Providers using the risk assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 out of 496 (47.8%); Tier 2, 185 out of 496 (37.3%); and Tier 3, 74 out of 496 (14.9%). Subsequent hospitalizations numbered 3 out of 237 (1.3%) for Tier 1, 15 out of 185 (8.1%) for Tier 2, and 17 out of 74 (23%) for Tier 3. From a Cox regression model with age of 60 years or older, gender, and reported obesity as covariates, the adjusted hazard ratios for hospitalization using Tier 1 as reference were 3.74 (95% CI 1.06-13.27; P=.04) for Tier 2 and 10.87 (95% CI 3.09-38.27; P<.001) for Tier 3. Conclusions A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified populations with low, intermediate, and high risk of hospitalization.
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Affiliation(s)
- James B O'Keefe
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Elizabeth J Tong
- Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Ghazala A Datoo O'Keefe
- Section of Vitreoretinal Surgery and Diseases, Section of Uveitis and Vasculitis, Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, United States
| | - David C Tong
- Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
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Houlding E, Mate KKV, Engler K, Ortiz-Paredes D, Pomey MP, Cox J, Hijal T, Lebouché B. Barriers to Use of Remote Monitoring Technologies Used to Support Patients With COVID-19: Rapid Review. JMIR Mhealth Uhealth 2021; 9:e24743. [PMID: 33769943 PMCID: PMC8059785 DOI: 10.2196/24743] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/03/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
Background The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. Objective The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. Methods A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. Results Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19–specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality “best practice” guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). Conclusions Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing “best practice” guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).
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Affiliation(s)
- Elizabeth Houlding
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kedar K V Mate
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - David Ortiz-Paredes
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Marie-Pascale Pomey
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Département de gestion, évaluation et politique de santé, École de santé publique de l'Université de Montréal, Montréal, QC, Canada
| | - Joseph Cox
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tarek Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, QC, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, Montréal, QC, Canada.,Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montréal, QC, Canada.,Department of Family Medicine, McGill University, Montréal, QC, Canada
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Abd-alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review (Preprint).. [DOI: 10.2196/preprints.29136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies.
OBJECTIVE
This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic.
METHODS
We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data.
RESULTS
Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%).
CONCLUSIONS
Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
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Agarwal P, Mukerji G, Laur C, Chandra S, Pimlott N, Heisey R, Stovel R, Goulbourne E, Bhatia RS, Bhattacharyya O, Martin D. Adoption, feasibility and safety of a family medicine-led remote monitoring program for patients with COVID-19: a descriptive study. CMAJ Open 2021; 9:E324-E330. [PMID: 33795222 PMCID: PMC8034257 DOI: 10.9778/cmajo.20200174] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Virtual care for patients with coronavirus disease 2019 (COVID-19) allows providers to monitor COVID-19-positive patients with variable trajectories while reducing the risk of transmission to others and ensuring health care capacity in acute care facilities. The objective of this descriptive analysis was to assess the initial adoption, feasibility and safety of a family medicine-led remote monitoring program, COVIDCare@Home, to manage the care of patients with COVID-19 in the community. METHODS COVIDCare@Home is a multifaceted, interprofessional team-based remote monitoring program developed at an ambulatory academic centre, the Women's College Hospital in Toronto. A descriptive analysis of the first cohort of patients admitted from Apr. 8 to May 11, 2020, was conducted. Lessons from the implementation of the program are described, focusing on measure of adoption (number of visits per patient total, with a physician or with a nurse; length of follow-up), feasibility (received an oximeter or thermometer; consultation with general internal medicine, social work or mental health, pharmacy or acute ambulatory care unit) and safety (hospitalizations, mortality and emergency department visits). RESULTS The COVIDCare@Home program cared for a first cohort of 97 patients (median age 41 yr, 67% female) with 415 recorded virtual visits. Patients had a median time from positive testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to first appointment of 3 (interquartile range [IQR] 2-4) days, with a median virtual follow-up time of 8 (IQR 5-10) days. A total of 4 (4%) had an emergency department visit, with no patients requiring hospitalization and no deaths; 16 (16%) of patients required support with mental and social health needs. INTERPRETATION A family medicine-led, team-based remote monitoring program can safely manage the care of outpatients diagnosed with COVID-19. Virtual care approaches, particularly those that support patients with more complex health and social needs, may be an important part of ongoing health system efforts to manage subsequent waves of COVID-19 and other diseases.
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Affiliation(s)
- Payal Agarwal
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont.
| | - Geetha Mukerji
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Celia Laur
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Shivani Chandra
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Nick Pimlott
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Ruth Heisey
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Rebecca Stovel
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Elaine Goulbourne
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - R Sacha Bhatia
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
| | - Danielle Martin
- Women's College Hospital Institute for Health System Solutions and Virtual Care (Agarwal, Mukerji, Laur, Chandra, Bhatia, Bhattacharyya), and Department of Family and Community Medicine (Agarwal, Bhattacharyya, Martin), and Division of Endocrinology & Metabolism (Mukerji), Department of Medicine, and Women's College Hospital Academic Family Health Team (Pimlott, Heisey), Department of Family and Community Medicine, and Division of General Internal Medicine (Stovel), Department of Medicine, University of Toronto; Division of General Internal Medicine (Stovel), Women's College Hospital; Women's College Hospital (Goulbourne, Martin); University Health Network (Bhatia); Dalla Lana School of Public Health (Martin), University of Toronto, Toronto, Ont
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45
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Hutchings OR, Dearing C, Jagers D, Shaw MJ, Raffan F, Jones A, Taggart R, Sinclair T, Anderson T, Ritchie AG. Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study. J Med Internet Res 2021; 23:e21064. [PMID: 33687341 PMCID: PMC7945978 DOI: 10.2196/21064] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/17/2020] [Accepted: 03/01/2021] [Indexed: 01/14/2023] Open
Abstract
Background Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers.
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Affiliation(s)
- Owen Rhys Hutchings
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Cassandra Dearing
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Dianna Jagers
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Miranda Jane Shaw
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Freya Raffan
- Royal Prince Alfred Virtual Hospital, Sydney Local Health District, Camperdown, Australia
| | - Aaron Jones
- Sydney Local Health District, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | | | - Tim Sinclair
- Sydney Local Health District, Camperdown, Australia
| | | | - Angus Graham Ritchie
- Sydney Local Health District, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Menzies Centre for Health Policy, University of Sydney, Sydney, Australia
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46
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Berezin L, Zhabokritsky A, Andany N, Chan AK, Estrada-Codecido J, Gershon A, Lam PW, Leis JA, MacPhee S, Mubareka S, Simor AE, Daneman N. Diagnostic accuracy of subjective dyspnoea in detecting hypoxaemia among outpatients with COVID-19: a retrospective cohort study. BMJ Open 2021; 11:e046282. [PMID: 34006036 PMCID: PMC7941675 DOI: 10.1136/bmjopen-2020-046282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The majority of patients with mild-to-moderate COVID-19 can be managed using virtual care. Dyspnoea is challenging to assess remotely, and the accuracy of subjective dyspnoea measures in capturing hypoxaemia have not been formally evaluated for COVID-19. We explored the accuracy of subjective dyspnoea in diagnosing hypoxaemia in COVID-19 patients. METHODS This is a retrospective cohort study of consecutive outpatients with COVID-19 who met criteria for home oxygen saturation monitoring at a university-affiliated acute care hospital in Toronto, Canada from 3 April 2020 to 13 September 2020. Dyspnoea measures were treated as diagnostic tests, and we determined their sensitivity (SN), specificity (SP), negative/positive predictive value (NPV/PPV) and positive/negative likelihood ratios (+LR/-LR) for detecting hypoxaemia. In the primary analysis, hypoxaemia was defined by oxygen saturation <95%; the diagnostic accuracy of subjective dyspnoea was also assessed across a range of oxygen saturation cutoffs from 92% to 97%. RESULTS During the study period, 89/501 (17.8%) of patients met criteria for home oxygen saturation monitoring, and of these 17/89 (19.1%) were diagnosed with hypoxaemia. The presence/absence of dyspnoea had limited accuracy for diagnosing hypoxaemia, with SN 47% (95% CI 24% to 72%), SP 80% (95% CI 68% to 88%), NPV 86% (95% CI 75% to 93%), PPV 36% (95% CI 18% to 59%), +LR 2.4 (95% CI 1.2 to 4.7) and -LR 0.7 (95% CI 0.4 to 1.1). The SN of dyspnoea was 50% (95% CI 19% to 81%) when a cut-off of <92% was used to define hypoxaemia. A modified Medical Research Council dyspnoea score >1 (SP 98%, 95% CI 88% to 100%), Roth maximal count <12 (SP 100%, 95% CI 75% to 100%) and Roth counting time <8 s (SP 93%, 95% CI 66% to 100%) had high SP that could be used to rule in hypoxaemia, but displayed low SN (≤50%). CONCLUSIONS Subjective dyspnoea measures have inadequate accuracy for ruling out hypoxaemia in high-risk patients with COVID-19. Safe home management of patients with COVID-19 should incorporate home oxygenation saturation monitoring.
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Affiliation(s)
- Linor Berezin
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Nisha Andany
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Adrienne K Chan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jose Estrada-Codecido
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Gershon
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Respirology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Philip W Lam
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jerome A Leis
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Scott MacPhee
- Department of Nursing, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samira Mubareka
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew E Simor
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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47
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Ferry OR, Moloney EC, Spratt OT, Whiting GFM, Bennett CJ. A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study. J Med Internet Res 2021; 23:e25518. [PMID: 33529157 PMCID: PMC7879714 DOI: 10.2196/25518] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. OBJECTIVE The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. METHODS Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. RESULTS Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). CONCLUSIONS Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care.
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Affiliation(s)
- Olivia R Ferry
- Metro North Hospital and Health Service, Brisbane, Australia
| | - Emma C Moloney
- Metro North Hospital and Health Service, Brisbane, Australia
| | - Owen T Spratt
- Metro North Hospital and Health Service, Brisbane, Australia
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48
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West TE, Schultz MJ, Ahmed HY, Shrestha GS, Papali A. Pragmatic Recommendations for Tracheostomy, Discharge, and Rehabilitation Measures in Hospitalized Patients Recovering From Severe COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2021; 104:110-119. [PMID: 33534772 PMCID: PMC7957235 DOI: 10.4269/ajtmh.20-1173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 12/14/2022] Open
Abstract
New studies of COVID-19 are constantly updating best practices in clinical care. However, research mainly originates in resource-rich settings in high-income countries. Often, it is impractical to apply recommendations based on these investigations to resource-constrained settings in low- and middle-income countries (LMICs). We report on a set of pragmatic recommendations for tracheostomy, discharge, and rehabilitation measures in hospitalized patients recovering from severe COVID-19 in LMICs. We recommend that tracheostomy be performed in a negative pressure room or negative pressure operating room, if possible, and otherwise in a single room with a closed door. We recommend using the technique that is most familiar to the institution and that can be conducted most safely. We recommend using fit-tested enhanced personal protection equipment, with the fewest people required, and incorporating strategies to minimize aerosolization of the virus. For recovering patients, we suggest following local, regional, or national hospital discharge guidelines. If these are lacking, we suggest deisolation and hospital discharge using symptom-based criteria, rather than with testing. We likewise suggest taking into consideration the capability of primary caregivers to provide the necessary care to meet the psychological, physical, and neurocognitive needs of the patient.
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Affiliation(s)
- T. Eoin West
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
| | - Marcus J. Schultz
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Hanan Y. Ahmed
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gentle S. Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Department of Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, Location ‘AMC’, Amsterdam, The Netherlands
- Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- Division of Pulmonary and Critical Care Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
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49
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Lun R, Walker G, Daham Z, Ramsay T, Portela de Oliveira E, Kassab M, Fahed R, Quateen A, Lesiuk H, P Dos Santos M, Drake B. Transition to virtual appointments for interventional neuroradiology due to the COVID-19 pandemic: a survey of satisfaction. J Neurointerv Surg 2020; 12:1153-1156. [PMID: 33028673 DOI: 10.1136/neurintsurg-2020-016805] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The COVID-19 pandemic has changed the way medicine is practiced, including the implementation of virtual care in many specialties. In the field of interventional neuroradiology (INR), virtual clinics are an uncommon practice with minimal literature to support its use. Our objective was to report prospective, single-centre data regarding patient and physician experience with virtual INR clinics for routine follow-up appointments. METHODS We surveyed all patients that participated in a virtual INR clinic follow-up appointment at our hospital over a 3 month period. Information gathered included length of appointment delays (ie, wait times), length of appointment times, overall satisfaction, and perceived safety metrics. A survey was also sent out to all physicians who participated in virtual clinics with similar questions. RESULTS 118/122 patients and 6/6 physicians completed the survey. Wait times before previous in-person appointments were perceived to be much longer than virtual appointments, whereas in-person appointment times were longer. 112/118 (94.9%) patients and 4/6 (67%) physicians reported general satisfaction with their virtual clinic experience. There were 8/118 patients who felt their conditions could not be safely assessed virtually, compared with 1/6 (17%) physicians. Lastly, 72.2% of patients reported that they would prefer virtual or telephone visits in the future for non-urgent follow-up, and 5/6 (83%) of physicians reported the same. CONCLUSION Virtual INR clinics are more efficient and are preferred among patients and physicians for non-urgent follow-up appointments. Our study demonstrates the feasibility of a virtual platform for INR care, which could be sustainable for future practice.
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Affiliation(s)
- Ronda Lun
- Neurology, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada .,Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Gregory Walker
- Neurology, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada.,Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine - Division of Neurology, Royal Columbian Hospital, New Westminster, British Columbia, Canada.,Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Zeinab Daham
- Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada
| | - Tim Ramsay
- Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Eduardo Portela de Oliveira
- Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mohammed Kassab
- Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Robert Fahed
- Neurology, Ottawa Hospital Civic Campus, Ottawa, Ontario, Canada.,Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Aiman Quateen
- Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Howard Lesiuk
- Department of Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Marlise P Dos Santos
- Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Drake
- Ottawa Stroke Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medical Imaging, Section of Interventional Neuroradiology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Neurosurgery, Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
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50
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Andany N, Daneman N. Home or Cabin. Chest 2020; 158:839-840. [PMID: 32892875 PMCID: PMC7468591 DOI: 10.1016/j.chest.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Nisha Andany
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Nick Daneman
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
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