背景:COVID-19大流行对采用远程医疗产生了巨大的刺激,该领域的许多举措已在世界范围内出现。然而,尽管有如此巨大的增长,关于远程医疗在临床结果方面的有效性的数据仍然很少.
目的:本研究的目的是评估在COVID-19大流行的背景下,采用结构化的多层次远程医疗服务对急性疾病过程中住院和成年流感综合征患者死亡率的影响。
方法:在巴西的两个城市进行了一项回顾性队列研究,这些城市部署了公共COVID-19远程医疗服务(TeleCOVID-MG)。TeleCOVID-MG是一种结构化的多级远程医疗服务,包括(1)通过聊天机器人软件或电话呼叫中心进行首次反应和风险分层,(2)与护士和医生的远程会诊,和(3)远程监护系统。对于这个分析,我们纳入了在2020年6月1日至2021年5月31日期间在流感综合征通知数据库中登记的诊断为流感综合征的成年患者的数据.暴露组包括在疾病过程中至少一次使用TeleCOVID-MG的流感综合征患者,对照组包括在呼吸系统疾病过程中未使用此远程医疗服务的患者。社会人口统计学特征,合并症,临床结果数据是从巴西流感综合征官方数据库中提取的,严重急性呼吸系统综合症(由于任何呼吸道病毒),和死亡率。通过逻辑回归估计临床结果的模型。
结果:最终研究人群包括82,182名在流感综合症通知系统中具有有效登记的成年患者。与未使用该服务的患者相比(n=67,689,82.4%),由TeleCOVID-MG支持的患者(n=14,493,17.6%)在急性呼吸系统疾病过程中住院的机会较低,即使在调整了社会人口统计学特征和基础医疗条件后(比值比[OR]0.82,95%CI0.71-0.94;P=.005).组间死亡率无差异(OR0.99,95%CI0.86-1.12;P=0.83)。
结论:在资源有限的地区大规模应用远程医疗服务来应对COVID-19与降低住院率而不增加死亡率有关。使用廉价且容易获得的远程医疗和数字医疗工具的优质医疗保健可能会在资源有限的地区提供,应被视为一种潜在且有价值的医疗保健策略。远程保健计划的成功取决于相关利益攸关方之间的伙伴关系,以确定角色和责任;在不同的医疗保健模式和水平之间建立一致性;并解决与实施过程有关的通常缺点,例如基础设施和可访问性问题。
BACKGROUND: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.
OBJECTIVE: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with
flu syndrome in the context of the COVID-19 pandemic.
METHODS: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with
flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with
flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for
flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression.
RESULTS: The final study population comprised 82,182 adult patients with a valid registry in the
Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83).
CONCLUSIONS: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues.