Authors: (including presenting author): :
Jiao FF(1), Ho KM(1), Chiang LK(1), Ko SH(1), Chen CXR(1)
Affiliation: :
(1)Department of Family Medicine and Primary Healthcare, Kowloon Central Cluster, Hospital Authority, Queen Elizabeth Hospital
Keyword 1: :
Telemedicine
Keyword 2: :
Primary Care
Keyword 4: :
Designated Clinics
Introduction: :
The use of telemedicine during the COVID-19 pandemic in primary care had been extensively documented. The Hospital Authority (HA) in Hong Kong started both Tele Designated Clinics (Tele-DC) and face-to-face physical DC (PDC) in managing COVID-19 patients with mild symptoms in community. It is unknown whether Tele-DC was as effective and PDC in managing COVID-19 patients with mild symptoms. We believed the findings of this study would provide evidence of application of Telemedicine in managing acute illness.
Objectives: :
To evaluate the effectiveness of Tele-DC in reducing hospitalization and severe complications among COVID-19 patients with mild symptoms managed in public primary care setting in Hong Kong.
Methodology: :
A retrospective cohort study was conducted to compare the effectiveness of Tele-DC with face-to-face PDC in managing COVID-19 patients. This study included all COVID-19 patients who attended PDC (N=23,031) or Tele-DC (N=38,628) at Kowloon Central Cluster of Hospital Authority (HA) in Hong Kong from 28 July 2022 to 29 January 2023. The selection criteria are patients 18 years or older and with a diagnosis of COVID-19. Patients managed by Tele-DC and PDC were matched using Propensity Score Matching based on age, sex, smoking status, comprehensive social security assistance (CSSA) status and Charlson comorbidity score. After propensity score matching, there were 17,199 patients in each group. The primary outcome was the hospital admission rate between day 1 and day 28 after first attendance at Tele-DC or PDC. Other outcomes include severe complication rate, mortality rate, emergency service utilization rate and DC reattendance rate. Patients characteristics, health service utilization, prescription of antiviral drugs, development of severe complications and mortality of COVID-19 patients attending the Tele-DC and PDC were compared. The data were collected from the Clinical Management System (CMS) or retrieved from the Clinical Data Analysis and Reporting System (CDARS) of HA.
Result & Outcome: :
Compared with PDC group, COVID-19 cases from Tele-DC group demonstrated similar hospital admission rate (Tele-DC vs PDC, 2.89% vs 2.74%, P=0.397), length of stay (LOS) (6.92±0.47 vs 6.61±0.50 days, P=0.656), severe complication rate (0.27% vs 0.19%, P =0.176), and mortality rate (0.13% vs 0.10%, P=0.390). However, patients from Tele-DC group exhibited a higher Accident and Emergency Department (AED) attendance rate (3.73% vs 3.15%, P=0.003) and DC re-attendance rate (8.41% vs 7.48%, P=0.002).The Tele-DC group also had lower anti-viral prescription rate (57.4% vs 62.78%, P< 0.001). This study was the first to evaluate the effectiveness of Telemedicine in managing COVID-19 patients with mild symptoms in primary care setting, using a large cluster-based cohort. Our study found that Tele-DC was as effective as face-to-face consultations in preventing hospitalization and severe cases among COVID-19 patients with mild symptoms in primary care setting.
