Telemonitoring of patients with COVID-19 at the primary care level: a pilot study results

Matic Mihevc, Diana Podgoršek, Marija Petek Šter

Keywords: COVID-19, telemedicine, primary care, hospitalisation, risk factors

Triage of patients with coronavirus disease 2019 (COVID-19) has placed tremendous pressure on primary care systems, particularly those with gatekeeping roles. Vital signs telemonitoring offers the opportunity to detect worsening disease and prompt hospitalisation rapidly. First, however, appropriate patients’ selection is necessary.

Research questions:
This study aimed to determine clinical characteristics and risk factors associated with hospitalisation of COVID-19 patients on telemedicine care.

A two-week follow-up study was conducted among 77 COVID-19 patients on telemedicine care. The study was conducted at PHC Trebnje between October 2020 and June 2021. Inclusion criteria were moderate COVID-19 symptoms, a positive PCR test, and the ability to use a pulse oximeter. At inclusion, sociodemographic and clinical data were collected using a structured questionnaire. Blood was also drawn for laboratory analysis. Subsequently, patients received a telemedicine package (pulse oximeter, measurement protocol) and were educated about critical vital signs values and when to activate emergency care. After inclusion, they were contacted every other day to report vital signs. Telemonitoring ended after 14 days without hospitalisation. Finally, data were analysed using descriptive statistics, log-rank test, and Cox proportional-hazards model.

The mean age of the population was 67.8±14.9 years, 64.9% were male, 66.2% had hypertension, 28.6% diabetes mellitus, 22.1% COPD or asthma, and 20.8% cardiovascular disease. Hospitalisation rate was 31.2%. The average time from inclusion to hospitalisation was 2.2 ± 2.6 days. In the Cox proportional-hazards model, diabetes mellitus (HR 3.68, 95% CI 1.16-11.69, p=0.027) and platelet count <150 x 10^9/L (HR 6.32, 95% CI 1.59-21.09, p=0.003) were independently predictive of hospitalisation within two weeks.

Vital signs telemonitoring is a feasible method of care for patients with moderate COVID-19 symptoms. Special care should be taken within the first five days, especially in patients over 60 years of age with diabetes and thrombocytopenia, as they are at high risk for hospitalisation.

Points for discussion:
What is your experience with telemedicine care? Have you implemented telemedicine care for COVID-19 patients in your health centre?

Do you think the model of telemedicine care for COVID-19 patients could later be expanded or applied to other chronic conditions (e.g., COPD, asthma, heart failure)?

What are the negative aspects of telemonitoring? How can they be addressed in the future?