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

Abstract

Background

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

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

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

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

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.

Keywords:

• COVID-19
• general practice
• hospitalisation
• telemedicine
• drug therapy

Acknowledgment

The pandemic exploded like a volcano, of which we have so far mainly observed lava (hospitalisations, deaths) and smoke (lack of knowledge, fake news); the ‘MAGMA Study’ aimed to evidence the magma: the submerged and hidden work of thousands of primary care front-line health professionals, and is dedicated to them. A special thanks goes to the members of the MAGMA Group; without your generosity and commitment to the profession of Family Medicine this study couldn’t have been possible: Maria Angela Acerbi, Claudio Andreoli, Mimmo Andreoli, Maria Rosa Bandieri, Francesco Bellelli, Chiara Bernabei, Monica Bevini, Maria Grazia Bonesi, Francesca Borsari, Paola Calzolari, Manfredo Campolieti, Emanuele Carnevale, Claudio Cavalieri, Simone Cernesi, Federica Collioli, Rita Morena Covizzi, Maria Rotonda D’Alterio, Daniela Dareggi, Roberto De Gesu, Laura Ermini, Gaetano Feltri, Nicoletta Fratti, Marinella Galletti, Manuela Gatto, Patrizia Ghirardini, Roberta Gilioli, Paola Grandi, Monica Lorenzini, Patrizia Lori, Sara Lucenti, Davide Luppi, Lisa Marcucci, Maria Marino, Chiara Moretti, Silvia Morisi, Maria, Claudia Polastri, Ilaria Pollacci, Francesca Riva, Carlo Riccò, Vanna Rinaldi, Alessandra Romani, Lanfranco Rossi, Lara Rovesta, Alberto Scaglioni, Marina Scarpa, Elisa Stefani. The MAGMA Group thanks Marco Saletti for the technical help writing the SQL query. Finally we would like to thank the reviewers and the editorial team for their comments with which helped us improve the quality and clarity of this manuscript.

Ethical approval

All procedures performed in studies involving human participants were per the ethical standards of the regional ethics committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The MAGMA study was approved by the local ethics committee Area Vasta Emilia Nord with the protocol number: on 21/07/2021 with protocol AOU 0022392/21.

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Data availability statement

The article’s data will be shared after a reasonable request to the corresponding author.

Additional information

Funding

The authors did not receive support from any organisation for the submitted work. All authors declare that they have no affiliations with or involvement in any organisation or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.