Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 13 de 13
Filter
1.
Cureus ; 14(12), 2022.
Article in English | EuropePMC | ID: covidwho-2169356

ABSTRACT

We report the case of a woman from the Bronx, New York, who presented to the emergency department (ED) in June 2020 with a febrile respiratory illness resembling coronavirus disease 2019 (COVID-19) but was ultimately diagnosed with Legionnaires' disease (LD). New York City (NYC) rapidly became an epicenter of the global COVID-19 pandemic in 2020. In the years since the pandemic started, variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have recurred in multiple waves and remain an important cause of viral respiratory illness. The bacteria Legionella pneumophila is often under-recognized as a cause of community-acquired pneumonia, yet it recurs each year in clusters, outbreaks, or as sporadic infections. Pneumonia caused by SARS-CoV-2 and Legionella can present similarly and may not be readily distinguished in the absence of diagnostic testing.

2.
Frontline Gastroenterology ; 2022.
Article in English | ProQuest Central | ID: covidwho-2118590

ABSTRACT

ObjectiveThe aim of this survey was to understand the impact of the COVID-19 pandemic and recovery phase on workload, well-being and workforce attrition in UK gastroenterology and hepatology.Design/methodA cross-sectional survey of British Society of Gastroenterology physician and trainee members was conducted between August and October 2021. Multivariable binary logistic regression and qualitative analyses were performed.ResultsThe response rate was 28.8% (180/624 of opened email invites). 38.2% (n=21/55) of those who contracted COVID-19 felt pressured to return to work before they felt ready. 43.8% (71/162) had a regular increase in out-of-hours working. This disproportionately affected newly appointed consultants (OR 5.8), those working full-time (OR 11.6), those who developed COVID-19 (OR 4.1) and those planning early retirement (OR 4.0). 92% (150/164) believe the workforce is inadequate to manage the service backlog with new consultants expressing the highest levels of anxiety over this. 49.1% (80/163) felt isolated due to remote working and 65.9% (108/164) felt reduced face-to-face patient contact made their job less fulfilling. 34.0% (55/162) planned to work more flexibly and 54.3% (75/138) of consultants planned to retire early in the aftermath of the pandemic. Early retirement was independently associated with male gender (OR 2.5), feeling isolated from the department (OR 2.3) and increased anxiety over service backlog (OR 1.02).ConclusionThe pandemic has placed an additional burden on work-life balance, well-being and workforce retention within gastroenterology and hepatology. Increased aspirations for early retirement and flexible working need to be explicitly addressed in future workforce planning.

3.
JMIR Form Res ; 6(5): e35674, 2022 May 17.
Article in English | MEDLINE | ID: covidwho-1847076

ABSTRACT

BACKGROUND: COVID-19 has had a catastrophic impact in terms of human lives lost. Medical education has also been impacted as appropriately stringent infection control policies precluded medical trainees from attending clinical teaching. Lecture-based education has been easily transferred to a digital platform, but bedside teaching has not. OBJECTIVE: This study aims to assess the feasibility of using a mixed reality (MR) headset to deliver remote bedside teaching. METHODS: Two MR sessions were led by senior doctors wearing the HoloLens headset. The trainers selected patients requiring their specialist input. The headset allowed bidirectional audiovisual communication between the trainer and trainee doctors. Trainee doctor conceptions of bedside teaching, impact of the COVID-19 pandemic on bedside teaching, and the MR sessions were evaluated using pre- and postround questionnaires, using Likert scales. Data related to clinician exposure to at-risk patients and use of personal protective equipment (PPE) were collected. RESULTS: Prequestionnaire respondents (n=24) strongly agreed that bedside teaching is key to educating clinicians (median 7, IQR 6-7). Postsession questionnaires showed that, overall, users subjectively agreed the MR session was helpful to their learning (median 6, IQR 5.25-7) and that it was worthwhile (median 6, IQR 5.25-7). Mixed reality versus in-person teaching led to a 79.5% reduction in cumulative clinician exposure time and 83.3% reduction in PPE use. CONCLUSIONS: This study is proof of principle that HoloLens can be used effectively to deliver clinical bedside teaching. This novel format confers significant advantages in terms of minimizing exposure of trainees to COVID-19, reducing PPE use, enabling larger attendance, and delivering convenient and accessible real-time clinical training.

4.
Open forum infectious diseases ; 8(Suppl 1):S466-S466, 2021.
Article in English | EuropePMC | ID: covidwho-1564647

ABSTRACT

Background The prompt recognition and treatment of Plasmodium falciparum is necessary to prevent death. We reviewed data from a cohort of patients presenting with malaria to Kings College Hospital NHS Trust, London. Methods Retrospective review of electronic records and drug charts of patients diagnosed with malaria from Jan 2019- March 2021. Results 109 cases of malaria were identified representing travellers from 11 Sub-Saharan African countries: Nigeria(38%), Sierra Leone(33%), Ivory Coast(10%). The age range varied from 4 to 76 years with a mean of 44, 66% of the cohort was male. 22 cases occurred during the COVID-19 Pandemic. The commonest symptoms were Fever (97%), Headache (92%) and malaise (72%). P. falciparum was present in 99% cases. A travel history was taken in 94% of cases. Malaria was considered by the first clinician in 82% of cases with the second highest differential being a viral illness. In 6 cases, it took 4 to 11 medical reviews before malaria was considered. 29 patients met the UK criteria for severe malaria. Door to antimalarial time varied from 1 to 128 hours, with a median of 7.4 hours. 46% of the cohort received intravenous Artesunate as their first antimalarial. Extreme delays occurred were clinicians did not consider malaria, patients had negative films or a patient did not declare a travel history when asked. 1 patient died of cerebral malaria with a door to needle time of 2hr 3min. Where a reason for delay is documented, drug availability represented the highest cause with mean delay from prescribing antimalarial to giving antimalarial of 2.7 hours. There was no difference in door to antimalarial administration during the COVID-19 Pandemic, but patients did have a delay in presentation to hospital from onset of symptoms, mean 6.2 days pre-pandemic, 10.5 days during pandemic, this was not statistically significant (P= 0.198). 3 patients presenting during the Pandemic had covid-19 swabs prior to admission and 10 had attended primary care services. Number of days between onset of malaria symptoms and presentation to the Emergency Department Box plot demonstrating that patients were waiting longer post symptom onset to access care in the Emergency Department. 3 patients had covid swabs in the community and 10 accessed care through their primary care physician. Conclusion Our data show that malaria is being considered early in the emergency department however there remain significant delays in administration of treatment. In 6 cases where malaria was not considered early there were delays in diagnosis of up to 5 days. An audit cycle will be completed with the aim of reducing door to antimalarial time. Disclosures All Authors: No reported disclosures

5.
Journal of the American Academy of Child & Adolescent Psychiatry ; 60(10):S242-S242, 2021.
Article in English | Academic Search Complete | ID: covidwho-1461217
6.
Blood ; 136(Supplement 1):25-25, 2020.
Article in English | PMC | ID: covidwho-1339096

ABSTRACT

IntroductionCOVID-19 is an ongoing pandemic that has impacted millions of individuals throughout the world. The spectrum of clinical features of COVID-19 can vary from asymptomatic infection to severe multiorgan failure leading to death. There is no single biomarker available that can predict the trajectory of the infected patient. Few clinical reports suggest a correlation between the severity of COVID-19 and elevation of certain hematological and inflammatory markers. We used a novel COVID-19 Prognostic Score (CPS) which included lymphocyte count, elevated lactate dehydrogenase (LDH), C-reactive protein (CRP) and ferritin levels to predict the outcomes of COVID-19 patients.MethodsWe performed a retrospective chart review of COVID-19 patients admitted to New York Presbyterian Brooklyn Methodist Hospital between March and April of 2020. Clinical data was extracted manually from electronic medical records. Patients were divided into 2 cohorts. The first cohort included a combination of low lymphocyte count, elevated LDH, CRP and ferritin. The second cohort included normal lymphocyte count, low LDH, CRP and ferritin. Low lymphocyte count was defined as <20% of white blood cell count (WBC), high LDH as ≥ 300 U/L, high CRP as ≥50mg/L and high ferritin as ≥600 ng/mL. Statistical analysis was performed by computing odds ratio using a p-value of <0.05 as statistically significant.ResultsWe analyzed 683 hospitalized patients who were diagnosed with COVID-19 confirmed via viral PCR resting. The median age was 66.5 years, males were 52.2% and blacks were 47.2%. 16.3% had coronary artery disease (CAD), 38.6% had Diabetes Mellitus (DM), 63.1% had hypertension and 21.6% had pulmonary disease. 181 patients (26.5%) were intubated and transferred to ICU. The median LDH was 438 U/L, the median CRP was 107 mg/L and the median ferritin was 687 ng/mL. 4.6% of patients developed a thromboembolic event. The overall inpatient mortality rate was 32.1%. There were 178 patients in the CPS-High cohort while there were 41 patients who qualified for the CPS-Low cohort. The median age of CPS-High was 65 years and the median age of CPS-Low was 58 years. The percentage of CAD, DM, hypertension, pulmonary disease in CPS-High and CPS-Low were 11.8%, 39.3%, 57.9%, 10.7% and 19.5%, 17.1%, 43.9%, 12.2% respectively. In the CPS-High cohort the overall inpatient mortality was 42% while the inpatient mortality rate for CPS-Low was 7.3%. In univariate analysis, patients who had CPS low had significantly reduced inpatient mortality (Odds ratio 0.108, 95% CI 0.03-0.36, p-value = 0.0003).DiscussionOur study suggests that a combination of hematological characteristics and inflammatory markers can be used to assess the severity of illness with COVID-19. This study shows that there is a likelihood of 6-times higher mortality with COVID-19 if all the clinical characteristics are abnormal including lymphocyte count, LDH, CRP, and ferritin. This simple clinical prognostic score can be used at the time of hospital admission to efficiently triage patients, which may likely improve the outcomes of these patients. This prognostic tool needs to be validated in a larger dataset or prospective clinical study.

7.
Blood ; 136(Supplement 1):27-28, 2020.
Article in English | PMC | ID: covidwho-1339093

ABSTRACT

Introduction:There is conflicting data on the association of blood type with COVID-19 infection. Recent studies have shown an association of blood type in acquisition of COVID-19 infection (Zhao et al., medRxiv 2020), but no association in terms of disease mortality (Latz, Ann Hematol 2020). Prior studies are limited due to lack of diversity. One of the largest studies conducted in China found blood type A conferred highest risk of acquiring COVID-19 infection (Zhao et al., medRxiv 2020). Similar results were found in which the odds of COVID-19 positive infection compared to negative test results were increased in blood group A and decreased in blood group O (Zietz et al., medRxiv 2020). There was no significant association between blood group and intubation or death. Neither of these studies addressed the association of blood groups with thromboembolism. This study aimed to evaluate the impact of blood types on outcomes of COVID-19 infection in a multiracial population.Methods:This is a retrospective electronic chart review of all patients admitted to New York-Presbyterian Brooklyn Methodist Hospital in Brooklyn, NY. All patients admitted from March 2020 to April 2020 who tested positive for SARS-CoV-2 nasopharyngeal swab were analyzed. Baseline patient characteristics and outcomes were entered manually by medical professionals via chart review using the electronic medical record (EMR). Baseline characteristics include blood group type, rhesus antigen status, age, gender, race, comorbid conditions, median initial and peak D-dimer. The primary endpoint was inpatient mortality. The secondary endpoints included thromboembolism (pulmonary embolism, deep venous thrombosis, arterial thrombosis), myocardial infarction, bleeding event, length of stay, intensive care unit admission, and intubation. Chi-square test for categorical variables was used to calculate statistical significance defined as p value ≤ .05 when comparing ABO blood group and rhesus antigen with mortality and development of thromboembolism.Results:Our study consisted of 249 patients that were COVID-19 positive with a documented blood group. Our population consisted of 51% of patients that identified as black, 35.7% that identified as white, and 17.7% that identified as Hispanic. Blood type B had the highest rate of patients that identified as black at 58.1% and blood type O had the highest rate that identified as Hispanic at 23.6%. When comparing blood groups A, AB, B and O to the rate of mortality the result was 46%, 44.4%, 41.9% and 50.9% respectively which was found to be not statistically significant (p=0.759). Rh positive patients had a 47.2% mortality rate while Rh negative patients had a 46.9% mortality rate however this was also found to be not statistically significant (p=0.954). Next, we compared development of thromboembolism during hospital stay in the A, AB, B, and O blood type groups and the rate was 8%, 11.1%, 9.3%, and 10.9% respectively with the results not being statistically significant when accounted for blood type (p=0.991). Rate of development of thromboembolism in Rh positive and negative patients was 9.3% and 9.4% respectively which was found to not be statistically significant as well (p=0.998). When looking at comorbidities, 70.2% of our patient population had hypertension and the second prevalent comorbidity was diabetes at 38.2% (Table 1).Discussion:In a diverse population, no association between ABO blood group, Rh status, and mortality was found which is similar to the conclusion found in prior studies done by Zhao et al. and Latz et al. in which the majority of the population was either Caucasian or Asian. Additionally, there is no association found between ABO blood group, Rh status and development of thromboembolism. Our patient population consisted mostly of minority groups.Prior studies have shown that blood type A has the highest risk of positive SARS-CoV-2 test whereas type O has the lowest risk of positive SARS-CoV-2 test. Our study further supplements this discovery by the conclusion that while blood type A confer ed highest risk of acquiring COVID-19 infection, blood type had no significant association with mortality. Investigation on a larger scale is necessary to address the susceptibility of ABO blood group and COVID-19 infection severity in a multiracial population to address racial disparities.

8.
Blood ; 136(Supplement 1):40-41, 2020.
Article in English | PMC | ID: covidwho-1339077

ABSTRACT

IntroductionThe outcomes related to different anticoagulation doses in Coronavirus disease 2019 (COVID-19) patients are not well established. COVID-19 is associated with increased thrombotic events and early coagulopathy as reported by a large New York City health system.Initial studies on patients in Wuhan, China showed anticoagulant therapy mainly with low molecular weight heparin was reported to be associated with better prognosis in severe COVID-19 patients meeting sepsis-induced coagulopathy criteria or with markedly elevated D-dimer. These studies fueled the need for anticoagulation protocols to be institutionalized broadly.Here we report the outcomes of patients on prophylactic compared to treatment dose anticoagulation early in the COVID-19 pandemic. This data reflects results before broad institutionalization of anticoagulation protocols for this novel disease in a Brooklyn, New York population.MethodsThis is a retrospective chart review of all laboratory confirmed COVID-19 patients who were admitted to New York-Presbyterian Brooklyn Methodist Hospital between March and April, 2020. Patient clinical characteristics were manually extracted from electronic medical records. Patients were divided into 2 groups: patients on treatment dose anticoagulation and patients on prophylactic dose anticoagulation. Primary outcome of this study was inpatient mortality among the two groups. Secondary outcomes were thromboembolisms (both arterial and venous), myocardial infarction (MI), major bleeding, ICU admission, ICU length of stay, invasive mechanical ventilation and initiation of dialysis. Odds ratio and p-values were obtained using univariate analysis.ResultsWe analyzed 580 hospitalized patients with confirmed nasopharyngeal COVID19 infection. Of these, 82 patients were on treatment dose anticoagulation 498 patients were on prophylactic dose. Median age was 70 years in treatment dose group and 66 years in prophylactic dose group. Percentage of males were similar between both groups (53%). African American race(56% vs 46%) was the predominant race in both groups. Median BMI was 28.1 in both groups. Percentage of smokers was higher in the treatment dose group (34% compared to 21%). Patients in the treatment dose group had a higher rate of all the comorbidities. Median D-Dimer (630 vs 590) was higher in the treatment dose group.Rates of ICU admission in treatment dose group and prophylactic dose group was 44% and 22% respectively. Patients requiring intubation (43% vs 24%) and transfusion (24% and 7%) were higher in the treatment dose group. There was an increased incidence of thromboembolic events in the treatment dose group as compared to prophylactic dose group with DVT (15.6% vs 1.6%) PE (3.7% vs 0.2%), arterial thrombosis (1.2% vs 0%) and MI (6.1% vs 1.6%). Incidence of major bleeding was higher in the treatment group (10% vs3.5%)DiscussionOur study found increased inpatient mortality with treatment dose anticoagulation and increased risk of bleeding when compared with prophylactic dose anticoagulation. These findings may be due to higher rates of comorbidities, smoking and older age when compared to the prophylactic anticoagulation group. Higher rates of bleeding raises concern for the safety of treatment dose anticoagulation in these populations.Some limitations of this study include: uneven sample size between the two groups and data was collected from patients before anticoagulation dose recommendations were standardized and officially implemented. Further randomized control trials are needed to evaluate the dose- dependent relationship between anticoagulation and mortality.Our study suggests that the treatment dose anticoagulation may adversely affect the outcomes in COVID-19 patients who are older and have multiple comorbidities. Therefore, the anticoagulation dose must be chosen carefully given the overall clinical picture.

9.
Blood ; 136(Supplement 1):12-13, 2020.
Article in English | PMC | ID: covidwho-1338971

ABSTRACT

BackgroundHypercoagulability is a well-known mechanism of injury in patients with COVID-19 (Rico-Mesa et al Cardiology 2020). There are several clinical reports suggesting higher incidence of venous as well as arterial thromboembolism in the infected individuals. Patients with evidence of thromboembolism are at higher risk of poor outcomes as well (Bilaloglu et al JAMA 2020). The underlying mechanism is thought to be due to increased platelet aggregation and activation (Manne et al Blood 2020) along with inflammatory activation of the coagulation cascade that can lead to a hypercoagulable state (McGonagle et al Lancet Rheumatology 2020). There is a suggestion that anticoagulation is associated with reduction in mortality in COVID-19 infections (Paranjpe et al Cardiology 2020). However, the role of antiplatelet therapy has not been very well described or studied. In this study we investigated the outcomes for patients who were on antiplatelet therapy or full dose anticoagulation at baseline who developed COVID-19 infections.MethodsThis is a retrospective electronic chart review of patients admitted to New York-Presbyterian Brooklyn Methodist Hospital (NYP BMH), a Weill Cornell Medicine-affiliated hospital in Brooklyn, NY. Patients who were diagnosed and hospitalized for COVID-19 between March to April 2020 were included. Clinical data was extracted manually from electronic medical record (EMR). Patients were divided into 3 cohorts, considered "high risk" due to chronic comorbidities which required therapeutic anticoagulation and/or antiplatelet therapy. The first cohort included patients on single or dual antiplatelet therapy (Aspirin, Clopidogrel, Ticagrelor, Prasugrel, Aspirin-Dipyridamole or dual antiplatelet therapy) prior to admission and continued on admission (AP only). The second cohort included patients on anticoagulation (therapeutic Coumadin, Apixaban, Rivaroxaban, Enoxaparin) without antiplatelet therapy prior to admission, and continued on equivalent anticoagulation inpatient (AC only). The third included patients who were on both antiplatelet therapy and therapeutic anticoagulation (AP + AC). Additionally, we collected data on baseline characteristics, demographics, and outcomes. The primary outcome of the study was inpatient mortality. Secondary outcomes were median length of stay, ICU admission, Intubation requirement, bleeding, transfusions of blood products, development of venous thromboembolism and myocardial infarction. Chi-squared analyses were performed to determine statistical significance.ResultsWe analysed 684 hospitalized patients who were diagnosed with COVID-19. Ages ranged from 18 to 101 years old, 52% were male, and 48% were black, with a median age of 70. There were 146 patients in the AP group, 34 patients in the AC group, 24 patients in the AP + AC group, and 480 patients were on neither. Our data was significant for mortality of 82% in the AC group, 36% in the AP group, and 38% in the AP + AC group (p value <0.00001). 37% of AP patients required ICU admission, 44% of AC patients, and 46% for AP + AC patients. 31% of AP patients required intubation, 32% of AC patients, and 21% of AP + AC patients. 24% of AC patients required at least 1 unit packed red blood cell transfusion, and 25% of AP + AC patients (Table 1).ConclusionWe determined our patients to be those at high risk of thrombosis at baseline due to their requirement of antiplatelets or anticoagulation prior to hospitalization for COVID-19 infection. Our study suggests that mortality is higher for these patients who already required anticoagulation prior to COVID infection. Significantly, we demonstrated that patients on both therapeutic anticoagulation and antiplatelet therapy had less mortality than patients on anticoagulation alone, suggesting that antiplatelets in addition to anticoagulation might be protective against mortality in COVID-19 infection. Additionally, patients on antiplatelets and anticoagulation had less development of respiratory failure requiring intubation than either alone. This study provides proof of concept for prospective clinical trials for assessing the role of combination of antiplatelet therapy and therapeutic anticoagulation in high risk patients.

10.
Am J Health Syst Pharm ; 78(Supplement_3): S76-S82, 2021 Aug 30.
Article in English | MEDLINE | ID: covidwho-1243455

ABSTRACT

PURPOSE: Patients with a reported ß-lactam allergy (BLA) are often given alternative perioperative antibiotic prophylaxis, increasing risk of surgical site infections (SSIs), acute kidney injury (AKI), and Clostridioides difficile infection (CDI). The purpose of this study was to implement and evaluate a pharmacist-led BLA clarification interview service in the preoperative setting. METHODS: A pharmacist performed BLA clarification telephone interviews before elective procedures from November 2018 to March 2019. On the basis of allergy history and a decision algorithm, first-line preoperative antibiotics, alternative antibiotics, or allergy testing referral was recommended. The pharmacist intervention (PI) group was compared to a standard of care (SOC) group who underwent surgery from November 2017 to March 2018. RESULTS: Eighty-seven patients were included, with 50 (57%) and 37 (43%) in the SOC and PI groups, respectively. The most common surgeries included orthopedic surgery in 41 patients (47%) and neurosurgery in 17 patients (20%). In the PI group, all BLA labels were updated after interview. Twenty-three patients were referred for allergy testing, 12 of the 23 (52%) completed BLA testing, and penicillin allergies were removed for 9 of the 12 patients. Overall, 28 of the 37 (76%) pharmacy antibiotic recommendations were accepted. Cefazolin use significantly increased from 28% to 65% after the intervention (P = 0.001). SSI occurred in 5 (10%) patients in the SOC group and no patients in the PI group (P = 0.051). All of these SSIs were associated with alternative antibiotics. Incidence of AKI and CDI was similar between the groups. No allergic reactions occurred in either group. CONCLUSION: Implementation of a pharmacy-driven BLA reconciliation significantly increased ß-lactam preoperative use without negative safety outcomes.


Subject(s)
Drug Hypersensitivity , Pharmacy , Anti-Bacterial Agents/adverse effects , Antibiotic Prophylaxis , Drug Hypersensitivity/diagnosis , Drug Hypersensitivity/epidemiology , Drug Hypersensitivity/prevention & control , Humans , Lactams , Retrospective Studies , beta-Lactams/adverse effects
11.
BMJ Open Qual ; 10(2)2021 05.
Article in English | MEDLINE | ID: covidwho-1214979

ABSTRACT

BACKGROUND: COVID-19 was declared a worldwide pandemic on 11 March 2020. Imperial College Healthcare NHS Trust provides 1412 inpatient beds staffed by 1200 junior doctors and faced a large burden of COVID-19 admissions. LOCAL PROBLEM: A survey of doctors revealed only 20% felt confident that they would know to whom they could raise concerns and that most were getting information from a combination of informal work discussions, trust emails, social media and medical literature. METHODS: This quality improvement project was undertaken aligning with Standards for Quality Improvement Reporting Excellence 2.0 guidelines. Through an iterative process, a digital network (Imperial Covid cOmmunications Network; ICON) using existing smartphone technologies was developed. Concerns were collated from the junior body and conveyed to the leadership team (vertical-bottom-up using Google Form) and responses were conveyed from leadership to the junior body (vertical-top-down using WhatsApp and Zoom). Quantitative analysis on engagement with the network (members of the group and number of issues raised) and qualitative assessment (thematic analysis on issues) were undertaken. RESULTS: Membership of the ICON WhatsApp group peaked at 780 on 17 May 2020. 197 concerns were recorded via the Google Form system between 20 March and 14 June 2020. There were five overarching themes: organisational and logistics; clinical strategy concerns; staff safety and well-being; clinical (COVID-19) and patient care; and facilities. 94.4% of members agreed ICON was helpful in receiving updates and 88.9% agreed ICON improved collaboration. CONCLUSIONS: This work demonstrates that a coordinated network using existing smartphone technologies and a novel communications structure can improve collaboration between senior leadership and junior doctors. Such a network could play an important role during times of pressure in a healthcare system.


Subject(s)
COVID-19/therapy , Communication , Medical Staff, Hospital/standards , Quality Improvement , Humans , Pandemics , SARS-CoV-2 , United Kingdom
12.
The American Journal of Geriatric Psychiatry ; 29(4, Supplement):S129-S130, 2021.
Article in English | ScienceDirect | ID: covidwho-1135423

ABSTRACT

Introduction The coronavirus pandemic has drastically affected day-to-day life, including the way healthcare is provided. An emphasis is placed on the need to transition to telemedicine to reduce exposure rates. The effects of the pandemic have been especially significant in the geriatric population, which is at increased risk of hospital mortality with infection: 35% mortality for patients aged 70 to 79 years and greater than 60% mortality for patients aged 80 to 89 years (Gómez-Belda et all., 2020, Wiersinga et al., 2020). Physicians, as well as patients, have had to quickly adapt to telemedicine for outpatient services to reduce rates of transmission and infection. However, the barriers to telemedicine are also higher in the geriatric population. The lack of smart devices with cameras, microphones, internet, and the lack of ability and comfort in using these are some of the barriers in which the older population face (Hawley, et al. 2020). With confounding factors of dementia limiting instrumental activities of daily living, learning new technology can also be an additional burden to this population. This can lead to unwillingness or hesitation in participation of telehealth visits by both the patient and the caretaker. An increase in caregiver burden has also been shown secondary to the coronavirus pandemic and the increased isolation (Alexopoulos et al., 2020). Methods At the Banner Alzheimer's Institute, the needs of this population led to the development of the Hybrid model of care, which allows some patients to be present in person at the office but distanced in a separate room from the providers. In a separate room, a screen with a camera is set up so the appointment can occur as a “remote” visit. When indicated, short direct contact is made to complete a physical exam. This reduced time of close contact is important for infection control, especially when as testing prior to visits is not widespread for outpatient services. Prolonged exposure is defined as within 6 feet of contact with infected persons for at least 15 minutes (Wiersinga et al., 2020). This hybrid model allows for decreased time of contact, and therefore decreases exposure risk while removing the initial barrier of access to and difficulty navigating technology in this population. With more hybrid visits, patients may even develop more comfort and confidence in technology use for fully remote visits. We analyzed data routinely collected by the department regarding patient and provider satisfaction. We analyzed ratings on front desk interactions, provider interactions, ease of care, office net promoter score (NPS), and provider NPS. We compared the ratings from June to October of 2020, when the hybrid model was in use, to the ratings from June to October of 2019 using a paired t-test. Results None of the measures analyzed showed any statistically significant difference between the scores. Conclusions To provide care to the high-risk geriatric population, we developed this hybrid model of treatment. A key concern was the potential for patient dissatisfaction with not being able to see the provider in person. However, this was not seen on the patient satisfaction survey results. One reason could be related to increased flexibility from patients considering the pandemic, the quality of video visits, and a perception of valuing safety over in person visits. In the evaluation of this model, using the typical measure of patient and provider satisfaction, we did not see significant differences between the previous and new models of care. This is an encouraging result and argues for the increased use of this hybrid model in the future to optimize infection prevention while maintaining patient satisfaction. With the use of the hybrid model, geriatric patients can be partially exposed to use of technology first in the office and be provided with in person tutorials on video use. This can normalize the use of video visits with time and practice and therefore lead to more confidence when applying the use of technology at home. The hybrid model can also mitigate concern over continuous exposure, and therefore address the wellbeing of physicians. Funding Not applicable

SELECTION OF CITATIONS
SEARCH DETAIL