COVID-19后初级保健护理在改善患有多种疾病的高龄患者生存率方面的效果:全港目标试验模拟

IF 2.6 3区 医学 Q1 PRIMARY HEALTH CARE
Cuiling Wei, Vincent Ka Chun Yan, Camille Maringe, Wenxin Tian, Rachel Yui Ki Chu, Wenlong Liu, Boyan Liu, Yuqi Hu, Lingyue Zhou, Celine Sze Ling Chui, Xue Li, Eric Yuk Fai Wan, Ching Lung Cheung, Esther Wai Yin Chan, William Chi Wai Wong, Ian Chi Kei Wong, Francisco Tsz Tsun Lai
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Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. Results A total of 6183 eligible COVID-19 survivors were included in the analysis. 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引用次数: 0

摘要

目标 患有多种疾病的老年人感染 COVID-19 并发症的风险较高。目前还很少研究 COVID-19 后干预措施或护理模式在减少这些患者后续不良后果方面的效果。本研究旨在探讨 COVID-19 出院后 30 天内到普通门诊就诊对 85 岁或以上多病老年人 1 年生存率的影响。设计 使用电子健康记录,模仿随机目标试验进行回顾性队列研究。背景 我们使用了香港医院管理局和卫生署的数据,这些数据为研究提供了全面的电子健康记录、COVID-19确诊病例数据、基于人口的疫苗接种记录和其他个人特征。参与者 2020年1月至2022年8月期间因COVID-19住院后出院的85岁或以上患有多种疾病的成年人。干预措施 COVID-19 最后一次出院后 30 天内到普通门诊就诊定义为暴露,与不去门诊就诊相比。主要结果测量 主要结果是一年内的全因死亡率。次要结果包括呼吸系统、心血管和癌症导致的死亡率。结果 共有 6183 名符合条件的 COVID-19 幸存者被纳入分析。COVID-19 住院后的全因死亡率在普通门诊就诊组(17.1 例/100 人-年)低于非就诊组(42.8 例/100 人-年)。经调整后,出院后 30 天内接受初级保健咨询的患者 1 年生存率明显更高(1 年生存率差异:11.2%,95% CI 8.1% 至 14.4%)。我们还观察到,普通门诊就诊组的呼吸系统疾病存活率明显更高(1 年存活率差异:6.3%,95% CI 3.5% 至 8.9%)。在对不同宽限期长度进行的敏感性分析中,我们发现参与者在 COVID-19 出院后越早接受普通门诊就诊,生存率越高。结论 COVID-19 住院后及时接受初级保健咨询可提高 85 岁或以上患有多病的老年人 COVID-19 住院后的存活率。扩大初级保健服务和实施后续机制对于支持这一弱势群体的康复和福祉至关重要。无数据。数据保管人未允许共享数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation
Objectives Older individuals with multimorbidity are at an elevated risk of infection and complications from COVID-19. Effectiveness of post-COVID-19 interventions or care models in reducing subsequent adverse outcomes in these individuals have rarely been examined. This study aims to examine the effectiveness of attending general outpatient within 30 days after discharge from COVID-19 on 1-year survival among older adults aged 85 years or above with multimorbidity. Design Retrospective cohort study emulating a randomised target trial using electronic health records. Setting We used data from the Hospital Authority and the Department of Health in Hong Kong, which provided comprehensive electronic health records, COVID-19 confirmed case data, population-based vaccination records and other individual characteristics for the study. Participants Adults aged 85 years or above with multimorbidity who were discharged after hospitalisation for COVID-19 between January 2020 and August 2022. Interventions Attending a general outpatient within 30 days of last COVID-19 discharge defined the exposure, compared to no outpatient visit. Main outcome measures Primary outcome was all-cause mortality within one year. Secondary outcomes included mortality from respiratory, cardiovascular and cancer causes. Results A total of 6183 eligible COVID-19 survivors were included in the analysis. The all-cause mortality rate following COVID-19 hospitalisation was lower in the general outpatient visit group (17.1 deaths per 100 person-year) compared with non-visit group (42.8 deaths per 100 person-year). After adjustment, primary care consultations within 30 days after discharge were associated with a significantly greater 1-year survival (difference in 1-year survival: 11.2%, 95% CI 8.1% to 14.4%). We also observed significantly better survival from respiratory diseases in the general outpatient visit group (difference in 1-year survival: 6.3%, 95% CI 3.5% to 8.9%). In a sensitivity analysis for different grace period lengths, we found that the earlier participants had a general outpatient visit after COVID-19 discharge, the better the survival. Conclusions Timely primary care consultations after COVID-19 hospitalisation may improve survival following COVID-19 hospitalisation among older adults aged 85 or above with multimorbidity. Expanding primary care services and implementing follow-up mechanisms are crucial to support this vulnerable population’s recovery and well-being. No data are available. The data custodian has not given permission for data sharing.
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来源期刊
CiteScore
9.70
自引率
0.00%
发文量
27
审稿时长
19 weeks
期刊介绍: Family Medicine and Community Health (FMCH) is a peer-reviewed, open-access journal focusing on the topics of family medicine, general practice and community health. FMCH strives to be a leading international journal that promotes ‘Health Care for All’ through disseminating novel knowledge and best practices in primary care, family medicine, and community health. FMCH publishes original research, review, methodology, commentary, reflection, and case-study from the lens of population health. FMCH’s Asian Focus section features reports of family medicine development in the Asia-pacific region. FMCH aims to be an exemplary forum for the timely communication of medical knowledge and skills with the goal of promoting improved health care through the practice of family and community-based medicine globally. FMCH aims to serve a diverse audience including researchers, educators, policymakers and leaders of family medicine and community health. We also aim to provide content relevant for researchers working on population health, epidemiology, public policy, disease control and management, preventative medicine and disease burden. FMCH does not impose any article processing charges (APC) or submission charges.
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