Implementation of community health care services to counter the SARS-CoV2 pandemic.
Community health care services
Emergency department
Hospitalization
Local health policy
Public health
SARS–CoV-2
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
01 Feb 2024
01 Feb 2024
Historique:
received:
01
01
2023
accepted:
16
01
2024
medline:
2
2
2024
pubmed:
2
2
2024
entrez:
2
2
2024
Statut:
epublish
Résumé
The COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden. We analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths. Being male (OR = 1.41, CI95% 1.05-1.90; p = 0.022) and older age (OR = 1.03, CI95% 1.02-1.04; p < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03-0.29; p < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09-0.65; p = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted. These measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.
Sections du résumé
BACKGROUND
BACKGROUND
The COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden.
METHODS
METHODS
We analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths.
RESULTS
RESULTS
Being male (OR = 1.41, CI95% 1.05-1.90; p = 0.022) and older age (OR = 1.03, CI95% 1.02-1.04; p < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03-0.29; p < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09-0.65; p = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted.
CONCLUSIONS
CONCLUSIONS
These measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.
Identifiants
pubmed: 38302959
doi: 10.1186/s12913-024-10607-x
pii: 10.1186/s12913-024-10607-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
158Informations de copyright
© 2024. The Author(s).
Références
Silva KRD, Souza FG, Roquete FF, Faria SMDC, Peixoto BCF, Vieira A. Allocation of resources for health care in COVID-19 pandemic times: integrative review. Rev Bras Enferm. 2020;73(suppl 2):e20200244.
doi: 10.1590/0034-7167-2020-0244
pubmed: 32965399
Zhong Y, Liu W, Lee TY, Zhao H, Ji J. Risk perception, knowledge, information sources and emotional states among COVID-19 patients in Wuhan, China. Nurs Outlook. 2021 Jan-Feb;69(1):13–21.
Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, et al. Emergency department visits for emergent conditions among older adults during the COVID-19 pandemic. J Am Geriatr Soc. 2021;69(7):1713–21. https://doi.org/10.1111/jgs.17227 .
doi: 10.1111/jgs.17227
pubmed: 33955546
pmcid: 8242842
Kansagra AP, Goyal MS, Hamilton S, Albers GW. Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med. 2020;383(4):400–1. https://doi.org/10.1056/NEJMc2014816 .
doi: 10.1056/NEJMc2014816
pubmed: 32383831
Melnick G, O’Leary JF, Zaniello BA, Abrishamian L. COVID-19 driven decline in emergency visits: has it continued, is it permanent, and what does it mean for emergency physicians? Am J Emerg Med. 2022;61:64–7. https://doi.org/10.1016/j.ajem.2022.08.031 .
doi: 10.1016/j.ajem.2022.08.031
pubmed: 36057210
pmcid: 9387065
Bhatt AS, Moscone A, McElrath EE, Varshney AS, Claggett BL, Bhatt DL, et al. Fewer hospitalizations for Acute Cardiovascular conditions during the COVID-19 pandemic. PNAS April. 2020;117(16):9122–6.
Pinnarelli L, Colais P, Mataloni F, Cascini S, Agabiti N, Fusco D et al. Access to the emergency at times of COVID-19: an analysis of the first three months in the Lazio region. Epidemiol Prev, Sep-Dec. 2020; 44 (5–6): 359– 66.
Muselli M, Cofini V, Mammarella L, Carmignani C, Fabiani L, Desideri G et al. October. The impact of COVID-19 pandemic on emergency services. Ann Ig, 2021; 16.
Arniani S, Nisticò F, Piacentini P. Prima analisi degli accessi al pronto soccorso durante i primi tre mesi dell’epidemia da COVID-19 nell’AUSL Toscana sud est e approfondimento su SDO. E&P Repository; May 2020.
Moghadasa SM, Shoukatb A, Fitzpatrickc MC, Wellsb CR, Sahb P, Pandeyb A, et al. Projecting hospital utilization during the COVID-19 outbreaks in the United States. Proc Natl Acad Sci U S A Apr. 2020;117(16):9122–6.
doi: 10.1073/pnas.2004064117
Patel KR, Kornreich ES, Rose P. Health Care Law brief. Lessons from the COVID-19 pandemic: planning for disaster preparedness and emergency management in hospitals. Proskauer Health Care Law Brief; October 2021.
Italian National Institute of Statistics. Demo. https://demo.istat.it . Last accessed: 24/11/2023.
Resolution of the Italian Council of Ministries dated 31. January 2020 - Dichiarazione dello stato di emergenza in conseguenza del rischio sanitario connesso all’insorgenza di patologie derivanti da agenti virali trasmissibili. https://www.osservatoriosullefonti.it/emergenza-COVID-19/fonti-governative/delibere-del-consiglio-dei-ministri/3008-emcov-deliberacdm1 . Last accessed: 30/12/2022.
Garg S, Kim L, Whitaker M, O’Halloran A, Cummings C, Holstein R, et al. Hospitalization rates and characteristics of patients hospitalized with laboratory-confirmed coronavirus disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR Morb Mortal Wkly Rep Apr. 2020;69(15):458–64.
doi: 10.15585/mmwr.mm6915e3
Guaitoli G, Pancrazi R. COVID-19: Regional policies and local infection risk: evidence from Italy with a modelling study. Lancet Reg Health– Europe. 2021;8:100169.
doi: 10.1016/j.lanepe.2021.100169
pubmed: 34308412