电话随访对法国首次 COVID-19 封锁期间慢性疾病患者发病率的影响（COVIQuest）：一项整群随机试验

Impact of a phone call with a medical student/general practitioner team on morbidity of chronic patients during the first French COVID-19 lockdown (COVIQuest): a cluster randomised trial.

机构信息

Department of General Practice, University of Tours, Tours, France

INSERM U1246, Tours, France.

出版信息

BMJ Open. 2022 Jul 28;12(7):e059464. doi: 10.1136/bmjopen-2021-059464.

DOI:10.1136/bmjopen-2021-059464

PMID:35902188

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9340580/

Abstract

OBJECTIVES

The first COVID-19 lockdown led to a significantly reduced access to healthcare, which may have increased decompensations in frail patients with chronic diseases, especially older patients living with a chronic cardiovascular disease (CVD) or a mental health disorder (MHD). The objective of COVIQuest was to evaluate whether a general practitioner (GP)-initiated phone call to patients with CVD and MHD during the COVID-19 lockdown could reduce the number of hospitalisation(s) over a 1-month period.

DESIGN

This is a cluster randomised controlled trial. Clusters were GPs from eight French regions.

PARTICIPANTS

Patients ≥70 years old with chronic CVD (COVIQuest_CV subtrial) or ≥18 years old with MHD (COVIQuest_MH subtrial).

INTERVENTIONS

A standardised GP-initiated phone call aiming to evaluate patients' need for urgent healthcare, with a control group benefiting from usual care (ie, the contact with the GP was by the patient's initiative).

MAIN OUTCOME MEASURES

Hospital admission within 1 month after the phone call.

RESULTS

In the COVIQuest_CV subtrial, 131 GPs and 1834 patients were included in the intervention group and 136 GPs and 1510 patients were allocated to the control group. Overall, 65 (3.54%) patients were hospitalised in the intervention group vs 69 (4.57%) in the control group (OR 0.82, 95% CI 0.56 to 1.20; risk difference -0.77, 95% CI -2.28 to 0.74). In the COVIQuest_MH subtrial, 136 GPs and 832 patients were included in the intervention group and 131 GPs and 548 patients were allocated to the control group. Overall, 27 (3.25%) patients were hospitalised in the intervention group vs 12 (2.19%) in the control group (OR 1.52, 95% CI 0.82 to 2.81; risk difference 1.38, 95% CI 0.06 to 2.70).

CONCLUSION

A GP-initiated phone call may have been associated with more hospitalisations within 1 month for patients with MHD, but results lack robustness and significance depending on the statistical approach used.

TRIAL REGISTRATION NUMBER

NCT04359875.

摘要

目的

第一次 COVID-19 封锁导致医疗保健的可及性显著降低，这可能导致患有慢性疾病的体弱患者病情恶化，尤其是患有慢性心血管疾病（CVD）或精神健康障碍（MHD）的老年患者。COVIQuest 的目的是评估在 COVID-19 封锁期间，全科医生（GP）对 CVD 和 MHD 患者进行电话随访是否可以减少 1 个月内的住院人数。

设计

这是一项集群随机对照试验。集群是来自法国八个地区的全科医生。

参与者

≥70 岁患有慢性 CVD（COVIQuest_CV 亚组）或≥18 岁患有 MHD（COVIQuest_MH 亚组）的患者。

干预措施

进行标准化的 GP 发起的电话随访，旨在评估患者对紧急医疗保健的需求，对照组受益于常规护理（即与 GP 的联系由患者主动发起）。

主要结局测量

电话随访后 1 个月内的住院情况。

结果

在 COVIQuest_CV 亚组中，131 名全科医生和 1834 名患者被纳入干预组，136 名全科医生和 1510 名患者被纳入对照组。总体而言，干预组有 65（3.54%）名患者住院，对照组有 69（4.57%）名患者住院（OR 0.82，95%CI 0.56 至 1.20；风险差异-0.77，95%CI-2.28 至 0.74）。在 COVIQuest_MH 亚组中，136 名全科医生和 832 名患者被纳入干预组，131 名全科医生和 548 名患者被纳入对照组。总体而言，干预组有 27（3.25%）名患者住院，对照组有 12（2.19%）名患者住院（OR 1.52，95%CI 0.82 至 2.81；风险差异 1.38，95%CI 0.06 至 2.70）。