Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2023.64.170
A remote care model for patients at high risk of hospital admission due to COVID-19 deterioration: who makes it at home? – a multicenter followup case from Slovenia
Matic Mihevc
; Department of Family Medicine, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
*
Diana Podgoršek
; Department of Family Medicine, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
Jakob Gajšek
; Primary Health Center Vrhnika, Vrhnika, Slovenia
Samanta Mikuletič
; Primary Health Center Postojna, Postojna, Slovenia
Vesna Homar
; Department of Family Medicine, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
Marko Kolšek
; Department of Family Medicine, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
Marija Petek Šter
; Department of Family Medicine, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
* Dopisni autor.
Sažetak
Aim To assess the feasibility of a remote care model for
high-risk COVID-19 patients, identify risk factors for hospital admission, and propose modifications to the tested
model.
Methods We conducted a multicenter observational
study of 225 patients (55.1% male) treated at three primary care centers between October 2020 and February 2022.
Patients were enrolled into a telemonitoring program if
they had a mild-moderate course of COVID-19 confirmed
by polymerase chain reaction testing and were classified
as high-risk for COVID-19 deterioration. Patients measured
their vital signs three times daily, consulted their primary care physician every other day, and were followed up
for 14 days. At inclusion, data were collected with a semistructured questionnaire, and blood was drawn for laboratory analysis. A multivariable Cox regression model was
used to determine predictors of hospital admission.
Results The median age was 62 years (range 24-94). The
hospital admission rate was 24.4%, and the mean time
from inclusion to hospital admission was 2.7±2.9 days.
A total of 90.9% of patients were hospitalized within the
first five days. A Cox regression model, adjusted for age,
sex, and the presence of hypertension, revealed that the
main predictors of hospital admission were type-2 diabetes (hazard ratio [HR] 2.38, 95% confidence interval [CI]
1.19-4.77, P=0.015) and thrombocytopenia (HR 2.46, 95%
CI 1.33-4.53, P=0.004).
Conclusion Telemonitoring of vital signs is a feasible
method of remote care that helps identify patients requiring immediate hospital admission. For further scale-up, we
suggest shortening call intervals in the first five days, when
the risk of hospital admission is highest, and giving special
attention to patients with type-2 diabetes and thrombocytopenia at inclusion.
Ključne riječi
Hrčak ID:
331526
URI
Datum izdavanja:
30.6.2023.
Posjeta: 277 *