Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Brazil.
Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil.
J Telemed Telecare. 2023 Feb;29(2):103-110. doi: 10.1177/1357633X20969529. Epub 2020 Oct 25.
Triage by on-demand telemedicine is a strategy for healthcare surge control in the COVID-19 pandemic. We aimed to assess the impact of a large-scale COVID-19 telemedicine system on emergency department (ED) visits and all-cause and cardiovascular hospital admissions in Brazil.
From March 18, 2020-May 18, 2020 we evaluated the database of a cooperative private health insurance, with 1.28 million clients. The COVID-19 telemedicine system consisted of: a) mobile app, which redirects to teleconsultations if indicated; b) telemonitoring system, with regular phone calls to suspected/confirmed COVID-19 cases to monitor progression; c) emergency ambulance system (EAS), with internet phone triage and counselling. ED visits and hospital admissions were recorded, with diagnoses assessed by the Diagnosis Related Groups method. COVID-19 diagnosis and deaths were identified from the patients' registries, and outcomes assessed until June 1st.
In 60 days, 24,354 patients accessed one of the telemedicine systems. The most frequently utilized was telemonitoring (16,717, 69%), followed by teleconsultation (13,357, 55%) and EAS (687, 3%). The rates of ED and hospital admissions were: telemonitoring 19.7% (3,296) and 4.7% (782); teleconsultation 17.3% (2,313) and 2.4% (318) and EAS: 55.9% (384) and 56.5% (388) patients. At total 4.1% (1,010) had hospital admissions, 36% (363) with respiratory diseases (44 requiring mechanical ventilation) and 4.4% (44) with cardiovascular diagnoses. Overall, 277 (1.1%) patients had confirmed COVID-19 diagnosis, and 160 (0.7%) died, 9 with COVID-19.
Telemedicine resulted in low rates of ED visits and hospital admissions, suggesting positive impacts on healthcare utilization. Cardiovascular admissions were remarkably rare.
按需远程医疗分诊是 COVID-19 大流行期间医疗保健激增控制的一种策略。我们旨在评估大规模 COVID-19 远程医疗系统对巴西急诊科 (ED) 就诊和全因及心血管医院入院的影响。
从 2020 年 3 月 18 日至 2020 年 5 月 18 日，我们评估了一个合作私人健康保险的数据库，该数据库拥有 128 万客户。COVID-19 远程医疗系统包括：a）移动应用程序，如果需要则重新定向到远程咨询；b）远程监测系统，对疑似/确诊 COVID-19 病例进行定期电话监测以监测进展；c）紧急救护车系统 (EAS)，通过互联网电话分诊和咨询。记录了 ED 就诊和住院情况，并通过诊断相关组方法评估诊断。从患者登记处确定 COVID-19 诊断和死亡，并评估至 6 月 1 日的结果。
在 60 天内，有 24,354 名患者使用了其中一种远程医疗系统。使用最多的是远程监测 (16,717 人，占 69%)，其次是远程咨询 (13,357 人，占 55%) 和 EAS (687 人，占 3%)。ED 和住院的发生率为：远程监测 19.7%（3,296 人）和 4.7%（782 人）；远程咨询 17.3%（2,313 人）和 2.4%（318 人）；EAS：55.9%（384 人）和 56.5%（388 人）。共有 4.1%（1,010 人）住院，36%（363 人）患有呼吸系统疾病（44 人需要机械通气），4.4%（44 人）患有心血管疾病诊断。总体而言，有 277 名（1.1%）患者确诊 COVID-19，有 160 名（0.7%）死亡，其中 9 人死于 COVID-19。
远程医疗导致 ED 就诊和住院率较低，表明对医疗保健利用产生了积极影响。心血管疾病入院非常罕见。
