Department of General Medicine, Nara City Hospital, Nara, Japan.
Department of Clinical Epidemiology, Hyogo Medical University, Hyogo, Japan.
Hosp Pract (1995). 2024 Aug;52(3):91-97. doi: 10.1080/21548331.2024.2337614. Epub 2024 Apr 3.
Hospitalists may work in a variety of clinical settings to manage COVID-19 cases. However, the extent of their involvement in COVID-19 care is unknown, particularly in hospitals without infectious disease (ID) specialists.
This study aimed to confirm whether hospitalists provided COVID-19 management in various clinical settings when ID specialists were unavailable. We conducted a multicenter cross-sectional study using a web-based questionnaire. The participants were full-time hospitalists working in Japanese academic community-based hospitals. The study period was from 15 January 2021 to 15 February 2021, during Japan's third wave of the COVID-19 pandemic. The primary outcome was the rate of hospitalists participating in COVID-19 inpatient management in hospitals with or without ID specialists.
ID specialists were absent in 31% of small hospitals (those with fewer than 249 registered beds), but only 4% of large hospitals ( < 0.001). Hospitalists were more likely to manage both COVID-19 inpatient care and emergency department care in hospitals without than with hospitals with ID specialists (76 versus 56% ( = 0.01) and 90 versus 73% ( = 0.01), respectively). After adjusting for confounders by multivariate analysis, hospitalists who worked in hospitals without ID specialists had higher odds of participating in COVID-19 inpatient care than those who worked in hospitals with such specialists (adjusted odds ratio: 3.0, 95% CI: 1.2-7.4).
Hospitalists were more likely to provide COVID-19 inpatient care in various clinical settings in hospitals without ID specialists.
医院医师可能在各种临床环境中工作，以管理 COVID-19 病例。然而，他们在 COVID-19 护理中的参与程度尚不清楚，尤其是在没有传染病（ID）专家的医院中。
本研究旨在确认在 ID 专家不可用时，医院医师是否在各种临床环境中提供 COVID-19 管理。我们使用基于网络的问卷进行了一项多中心横断面研究。参与者是在日本学术社区医院工作的全职医院医师。研究期间为 2021 年 1 月 15 日至 2021 年 2 月 15 日，正值日本 COVID-19 疫情的第三波。主要结局是在有或没有 ID 专家的医院中，医院医师参与 COVID-19 住院管理的比例。
在小医院（注册床位少于 249 张）中，ID 专家缺席的比例为 31%，但在大医院（ < 0.001）中仅为 4%。与有 ID 专家的医院相比，在没有 ID 专家的医院中，医院医师更有可能管理 COVID-19 住院患者和急诊科患者（分别为 76%比 56%（ = 0.01）和 90%比 73%（ = 0.01））。通过多变量分析调整混杂因素后，与在有 ID 专家的医院工作的医院医师相比，在没有 ID 专家的医院工作的医院医师更有可能参与 COVID-19 住院患者的治疗（调整后的优势比：3.0，95%CI：1.2-7.4）。
在没有 ID 专家的医院中，医院医师更有可能在各种临床环境中提供 COVID-19 住院患者的治疗。
