ABSTRACT
Background: During the COVID-19 pandemic, outpatient clinics in National Guard-Health Affairs Hospitals, Saudi Arabia, have shifted their healthcare services towards virtual clinics to keep up with patient appointments while maintaining infection control precautions. This study aimed to determine if patient attendance compliance has changed by implementing virtual "phone call" appointments compared to the conventional physical appointments in outpatient clinics. Methods: This comparative cross-sectional study was conducted by comparing patients' demographic information, and compliance to virtual calls and physician recommendations during 2020 with the regular physical attendance clinics in 2019. Patient data was collected from the electronic medical records after randomly selecting the sample for each year from 6 main outpatient clinics. Results: During the 4-month period of 2020 (March-June), in which virtual clinics were implemented, there was a significant decrease in the attendance compliance when compared to the same period in 2019 conventional clinics. Data were analyzed for 404 and 407 patients' medical records from each year, respectively. The drop in the clinic attendance compliance was the highest in the pediatric oncology clinic. Moreover, physician orders of investigations and medications were significantly reduced. Conclusion: COVID-19 pandemic had a significant negative impact on patient care. Although that impact was seen greatest among those with chronic conditions and oncology patients, it was an essential step towards infection control during this difficult period. However, the pandemic is an opportunity to establish a comprehensive virtual care system that will ensure easy access and continuity of patient care. [ FROM AUTHOR] Copyright of Middle East Journal of Family Medicine is the property of Medi+WORLD International Pty. Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
INTRODUCTION: Antiviral drugs have shown limited effectiveness in treating patients with coronavirus disease 2019 (COVID-19). We aimed to assess the effects of a favipiravir and hydroxychloroquine combination on treating moderate-to-severe COVID-19 patients. METHODS: An investigator-initiated, multicenter, open-label, randomized trial at nine hospitals. Eligible patients were adults with moderate-to-severe COVID-19 defined as oxygen saturation (SaO2) of ≤ 94% while breathing ambient air or significant clinical symptoms with chest x-ray changes requiring hospital admission. Randomization was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The primary outcome was time to clinical improvement of two points (from the status at randomization) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population. RESULTS: From May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 to the treatment. The mean age was 52 (± 13) years, and 103 (41%) were women. At randomization, six patients were on invasive mechanical ventilation, 229 (90.15%) were requiring supplemental oxygen only (with or without non-invasive ventilation), and 19 (7.48%) were receiving neither. The time to clinical improvement was not significantly different between the groups: median of 9 days in the treatment group and 7 days in the control group (HR: 0.845; 95% CI 0.617-1.157; p-value = 0.29). The 28-day mortality was not significantly different between the groups (7.63% treatment) vs. (10.32% control); p-value = 0.45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group. CONCLUSION: The combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT04392973).