HOW TO TREAT: COVID-19 in primary care

ABSTRACT

Other key aspects of monitoring include * A clinician who knows the patient and has access to their regular health records, evidence-based resources to guide monitoring, and a template for systematic monitoring and recording. * A systematic approach to ensure no one falls through the cracks, and a clinic-wide team approach so all staff understand the system and their roles in it. * Patient access to a pulse oximeter;where risk indicates need;and information for patients on illness course, red flags, safety net systems and self-management strategies. * Understanding of local access to support for basic needs (food, shelter, communication). Monitoring Beyond initial set-up and triage for current red flags, there are four main aspects to monitoring patients with COVID-19 in primary care risk assessment and determining monitoring frequency;assessment of current symptoms and change from previous;assessment of current vital signs and oxygen saturation, and changes in these from recent;hydration and assessment for red flags indicating the patient should be transferred to hospital for further assessment. If not transferred, such patients should be monitored as high risk * is socially isolated (lives alone, unable to connect with others through technology, little to no social network) * lacks caregiver support, if needed (including a safe environment for care of children) * is unable to maintain hydration (diarrhoea, vomiting, cognitive impairment, poor fluid intake) * has food or financial insecurity * receives home-care support * has challenges with health literacy or ability to understand treatment recommendations or isolation expectations * is unable to self-manage. Other important goals of monitoring are to reassure patients who do not need hospital-level care and to provide education on illness course, safety net instructions, advice on symptom management and attention to mental health impacts of a positive diagnosis (a positive diagnosis is anxiety-provoking for anyone, and particularly for those who are aware they are at greater risk).