A Primary Health Care Program and COVID-19. Impact in Hospital Admissions and Mortality

• Published in: Journal of general internal medicine : JGIM 2024-11, Vol.39 (14), p.2662-2670
• Main Authors: García-Marichal, Cristina, Aguilar-Jerez, Manuel Francisco, Delgado-Plasencia, Luciano Jonathan, Pérez-Hernández, Onán, Armas-González, José Fernando, Pelazas-González, Ricardo, Martín-González, Candelaria
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; COVID-19; COVID-19 - epidemiology; COVID-19 - mortality; COVID-19 - therapy; Design factors; Female; Health care; Health risks; Hospitalization - statistics & numerical data; Hospitals; Humans; Infections; Kidney diseases; Male; Malignancy; Middle Aged; Mortality; Mortality risk; Original Research; Oxygen; Oxygen content; Oxygen saturation; Patient admissions; Patients; Primary care; Primary Health Care - organization & administration; Respiration; Respiratory diseases; Respiratory rate; Retrospective Studies; Risk assessment; SARS-CoV-2; Spain - epidemiology; Telemedicine
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-024-08912-6

Most patients with mild or moderate COVID infection did not require hospital admission, but depending on their personal history, they needed medical supervision. In monitoring these patients in primary care, the design of specific surveillance programs was of great help. Between February 2021 and March 2022, EDCO program was designed in Tenerife, Spain, to telemonitor patients with COVID infection who had at least one vulnerability factor to reduce hospital admissions and mortality. The aim of this study is to describe the clinical course of patients included in the EDCO program and to analyze which factors were associated with a higher probability of hospital admission and mortality. Retrospective cohort study. We included 3848 patients with a COVID-19 infection age over 60 years old or age over 18 years and at least one vulnerability factor previously reported in medical history. Primary outcome was to assess risk of admission or mortality. 278 (7.2%) patients required hospital admission. Relative risks (RR) of hospital admission were oxygen saturation ≤ 92% (RR: 90.91 (58.82-142.86)), respiratory rate ≥ 22 breaths per minute (RR: 20.41 (1.19-34.48), obesity (RR: 1.53 (1.12-2.10), chronic kidney disease (RR:2.31 (1.23-4.35), ≥ 60 years of age (RR: 1.44 (1.04-1.99). Mortality rate was 0.7% (27 patients). Relative risks of mortality were respiratory rate ≥ 22 breaths per minute (RR: 24.85 (11.15-55.38), patients with three or more vulnerability factors (RR: 4.10 (1.62-10.38), oxygen saturation ≤ 92% (RR: 4.69 (1.70-15.15), chronic respiratory disease (RR: 3.32 (1.43-7.69) and active malignancy (RR: 4.00 (1.42-11.23). Vulnerable patients followed by a primary care programme had admission rates of 7.2% and mortality rates of 0.7%. Supervision of vulnerable patients by a Primary Care team was effective in the follow-up of these patients with complete resolution of symptoms in 91.7% of the cases.