The effects of primary care monitoring strategies on COVID-19 related hospitalisation and mortality: a retrospective electronic medical records review in a northern Italian province, the MAGMA study.
COVID-19
drug therapy
general practice
hospitalisation
telemedicine
Journal
The European journal of general practice
ISSN: 1751-1402
Titre abrégé: Eur J Gen Pract
Pays: England
ID NLM: 9513566
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
medline:
8
6
2023
pubmed:
20
4
2023
entrez:
20
04
2023
Statut:
ppublish
Résumé
Most symptomatic SARS-CoV-2 infections produce mild to moderate symptoms. Although most patients are managed in the outpatient setting, little is known about the effect of general practitioners' (GP) management strategies on the outcomes of COVID-19 outpatients in Italy. Describe the management of Italian GPs of SARS-CoV-2 infected adult patients and explore whether GP active care and monitoring are associated with reducing hospitalisation and death. Retrospective observational study of SARS-CoV-2 infected adult outpatients managed by GPs in Modena (Italy) from March 2020 to April 2021. Information on management and monitoring strategies, patients' socio-demographic characteristics, comorbidities, and outcomes (hospitalisation and death due to COVID-19) were retrieved through an electronic medical record review and analysed descriptively and through multiple logistic regression. Out of the 5340 patients from 46 GPs included in the study, 3014 (56%) received remote monitoring, and 840 (16%) had at least one home visit. More than 85% of severe or critical patients were actively monitored (73% daily) and 52% were visited at home. Changes over time in patients' therapeutic management were observed in concordance with the guidelines' release. Active daily remote monitoring and home visits were strongly associated with reduced hospitalisation rate (OR 0.52, 95% CI 0.33-0.80 and OR 0.50, 95% CI 0.33-0.78 respectively). GPs effectively managed an increasing number of outpatients during the first waves of the pandemic. Active monitoring and home visits were associated with reduced hospitalisation in COVID-19 outpatients.
Sections du résumé
BACKGROUND
UNASSIGNED
Most symptomatic SARS-CoV-2 infections produce mild to moderate symptoms. Although most patients are managed in the outpatient setting, little is known about the effect of general practitioners' (GP) management strategies on the outcomes of COVID-19 outpatients in Italy.
OBJECTIVES
UNASSIGNED
Describe the management of Italian GPs of SARS-CoV-2 infected adult patients and explore whether GP active care and monitoring are associated with reducing hospitalisation and death.
METHODS
UNASSIGNED
Retrospective observational study of SARS-CoV-2 infected adult outpatients managed by GPs in Modena (Italy) from March 2020 to April 2021. Information on management and monitoring strategies, patients' socio-demographic characteristics, comorbidities, and outcomes (hospitalisation and death due to COVID-19) were retrieved through an electronic medical record review and analysed descriptively and through multiple logistic regression.
RESULTS
UNASSIGNED
Out of the 5340 patients from 46 GPs included in the study, 3014 (56%) received remote monitoring, and 840 (16%) had at least one home visit. More than 85% of severe or critical patients were actively monitored (73% daily) and 52% were visited at home. Changes over time in patients' therapeutic management were observed in concordance with the guidelines' release. Active daily remote monitoring and home visits were strongly associated with reduced hospitalisation rate (OR 0.52, 95% CI 0.33-0.80 and OR 0.50, 95% CI 0.33-0.78 respectively).
CONCLUSION
UNASSIGNED
GPs effectively managed an increasing number of outpatients during the first waves of the pandemic. Active monitoring and home visits were associated with reduced hospitalisation in COVID-19 outpatients.
Identifiants
pubmed: 37079345
doi: 10.1080/13814788.2023.2186395
pmc: PMC10249457
doi:
Types de publication
Observational Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2186395Investigateurs
Maria Angela Acerbi
(MA)
Claudio Andreoli
(C)
Mimmo Andreoli
(M)
Maria Rosa Bandieri
(MR)
Francesco Bellelli
(F)
Chiara Bernabei
(C)
Monica Bevini
(M)
Maria Grazia Bonesi
(MG)
Francesca Borsari
(F)
Paola Calzolari
(P)
Manfredo Campolieti
(M)
Emanuele Carnevale
(E)
Claudio Cavalieri
(C)
Simone Cernesi
(S)
Federica Collioli
(F)
Rita Morena Covizzi
(RM)
Maria Rotonda D'Alterio
(MR)
Daniela Dareggi
(D)
Roberto De Gesu
(R)
Laura Ermini
(L)
Gaetano Feltri
(G)
Nicoletta Fratti
(N)
Marinella Galletti
(M)
Manuela Gatto
(M)
Patrizia Ghirardini
(P)
Roberta Gilioli
(R)
Paola Grandi
(P)
Monica Lorenzini
(M)
Patrizia Lori
(P)
Sara Lucenti
(S)
Davide Luppi
(D)
Lisa Marcucci
(L)
Maria Marino
(M)
Chiara Moretti
(C)
Silvia MorisiMaria
(S)
Claudia Polastri
(C)
Ilaria Pollacci
(I)
Francesca Riva
(F)
Carlo Riccò
(C)
Vanna Rinaldi
(V)
Alessandra Romani
(A)
Lanfranco Rossi
(L)
Lara Rovesta
(L)
Alberto Scaglioni
(A)
Marina Scarpa
(M)
Elisa Stefani
(E)
Références
Recenti Prog Med. 2020 Jun;111(6):351-353
pubmed: 32573549
Healthcare (Basel). 2020 Jun 03;8(2):
pubmed: 32503304
BMJ Open. 2021 Mar 10;11(3):e046044
pubmed: 33692188
J Am Board Fam Med. 2021 Feb;34(Suppl):S222-S224
pubmed: 33622842
Lancet Digit Health. 2022 Apr;4(4):e279-e289
pubmed: 35337644
Br J Gen Pract. 2021 Jul 29;71(709):e634-e642
pubmed: 33979303
Eur J Clin Pharmacol. 2003 Nov;59(8-9):651-7
pubmed: 13680039
Fam Pract. 2011 Aug;28(4):352-4
pubmed: 21791530
Chin Med J (Engl). 2020 May 5;133(9):1015-1024
pubmed: 32004165
J Clin Med. 2021 Dec 23;11(1):
pubmed: 35011810
China CDC Wkly. 2020 Feb 21;2(8):113-122
pubmed: 34594836
Front Public Health. 2021 Feb 03;9:623904
pubmed: 33614587
Recenti Prog Med. 2021 May;112(5):338-342
pubmed: 34003185
Epidemiol Prev. 2020 Sep-Dec;44(5-6 Suppl 2):33-41
pubmed: 33412792
Ann Intern Med. 2020 Sep 1;173(5):405-407
pubmed: 32294152
Infect Control Hosp Epidemiol. 2021 Mar;42(3):364-365
pubmed: 32408922
BJGP Open. 2020 May 1;4(1):
pubmed: 31992543
BMJ Open. 2020 Jul 6;10(7):e038843
pubmed: 32636291
Rev Esp Salud Publica. 2022 Feb 14;96:
pubmed: 35156653
Lancet. 2007 Oct 20;370(9596):1453-7
pubmed: 18064739
Aten Primaria. 2021 Oct;53(8):102134
pubmed: 34237607