Telemedicine Department, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
Einstein (Sao Paulo). 2024 Jul 8;22:eAO0707. doi: 10.31744/einstein_journal/2024AO0707. eCollection 2024.
The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols.
A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections.
Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%.
Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
远程医疗出院的疑似呼吸道感染患者的护理质量和安全性与不合理和高风险药物处方率低密切相关。本回顾性研究旨在利用多药管理方案评估在一个大型中心使用直接面向消费者的远程医疗进行时，对当前 COVID-19 指南的遵循情况。
季度电子调查利用个体医生护理的病历评估了各种质量指标。医生根据个人指标接受持续的适应性反馈，远程医疗中心的建议来自 2020 年传染病学会指南。该研究包括 2020 年 3 月至 2021 年 8 月期间，在过去 14 天内出现新呼吸道症状并寻求自发远程医疗咨询的所有连续成年患者。本研究分析了疑似或确诊 COVID-19 以及其他气道感染的患者。
在评估的 221128 例患者中，42042 例（19%）确诊 COVID-19；104021 例（47%）疑似 COVID-19；75065 例（33%）其他诊断。疑似或确诊 COVID-19 患者的平均（+DP）年龄为 35±12 岁。共有 125107 例（85.65%）患者在家庭中得到管理，2552 例（1.74%）被转介到非紧急门诊重新评估，17185 例（11.7%）被转介到急诊室，没有进一步的治疗建议。确诊或疑似 COVID-19 病例中抗生素的使用率为 0.46%/0.65%，非循证处方的使用率为 0.01%/0.005%。
指南培训和远程医疗咨询反馈可能导致疑似和确诊 COVID-19 病例中抗生素和抗菌药物处方减少。多药管理方案可提高指南的遵循率，并加强远程医疗中护理质量和安全性。
