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. 2024 Feb 1;24(1):158.
doi: 10.1186/s12913-024-10607-x.

Implementation of community health care services to counter the SARS-CoV2 pandemic

Assunta De Luca  1 , Luca Provvidenti  1 , Mario Muselli  2 , Giacinto Di Gianfilippo  1 , Massimiliano Angelucci  1 , Michele Ciro Totaro  1 , Mauro Pitorri  1 , Marzia Marcelli  3 , Marinella D'Innocenzo  1 , Maria Scatigna  3 , Riccardo Mastrantonio  3 , Stefano Necozione  3 , Leila Fabiani  3
Affiliations

Implementation of community health care services to counter the SARS-CoV2 pandemic

Assunta De Luca et al. BMC Health Serv Res. .

Abstract

Background: The COVID-19 pandemic has ravaged many countries worldwide since December 2019. The high infection rates, and the need for health care assistance for individuals with comorbidities, strained the national health care systems around the world. Outbreak peaks increased the burden on hospitals that where perceived as high-risk places by people, who often decided to cancel or defer hospital visits. Thus, Italian Local Health Authorities had to develop new organizational models to meet the increased health care needs of the population. The aim of this study is to assess the impact of strengthened community health services on the hospital burden.

Methods: We analysed the number of Emergency Department access at the Hospital De Lellis covered by the Local Health Authority in Rieti, from March 2020 to November 2021. We then assessed the effects of community health services: the Special District Continuing Care Units (SDCUs) and the the COVID hub, on the COVID-19-related ED access, admission and mortality rates. A Chi-squared test for trend and three multivariable logistic regression models were used to investigate the trends and the possible predictors of COVID ED access, COVID hospital admissions, and deaths.

Results: Being male (OR = 1.41, CI95% 1.05-1.90; p = 0.022) and older age (OR = 1.03, CI95% 1.02-1.04; p < 0.0001) increase the likelihood of hospitalisation for Sars-CoV-2. The implementation of the nursing and medical SDCUs contributed to reducing COVID-19-related deaths (OR = 0.09, CI95% 0.03-0.29; p < 0.0001). The simultaneous implementation of the COVID hub and of the nursing SDCUs had a synergistic effect in reducing the likelihood of hospitalisation (OR = 0.24, CI95% 0.09-0.65; p = 0.005). The subsequent implementation of the medical SDCUS has further contributed to lowering the admission rates. These protective effects persisted also after potential cofounders, such as age, sex, clinical condition on admission, and the immunisation status, were adjusted.

Conclusions: These measures have helped in the management of patients in a complex context such as that of a pandemic by reducing the hospital load and playing an important role in the management of the pandemic. Further studies could assess the transferability of this model in a non-pandemic context.

Keywords: Community health care services; Emergency department; Hospitalization; Local health policy; Public health; SARS–CoV-2.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of the measures implemented
See this image and copyright information in PMC

References

    1. Silva KRD, Souza FG, Roquete FF, Faria SMDC, Peixoto BCF, Vieira A. Allocation of resources for health care in COVID-19 pandemic times: integrative review. Rev Bras Enferm. 2020;73(suppl 2):e20200244. doi: 10.1590/0034-7167-2020-0244. - DOI - PubMed
    1. Zhong Y, Liu W, Lee TY, Zhao H, Ji J. Risk perception, knowledge, information sources and emotional states among COVID-19 patients in Wuhan, China. Nurs Outlook. 2021 Jan-Feb;69(1):13–21. - PMC - PubMed
    1. Janke AT, Jain S, Hwang U, Rosenberg M, Biese K, Schneider S, et al. Emergency department visits for emergent conditions among older adults during the COVID-19 pandemic. J Am Geriatr Soc. 2021;69(7):1713–21. doi: 10.1111/jgs.17227. - DOI - PMC - PubMed
    1. Kansagra AP, Goyal MS, Hamilton S, Albers GW. Collateral effect of Covid-19 on stroke evaluation in the United States. N Engl J Med. 2020;383(4):400–1. doi: 10.1056/NEJMc2014816. - DOI - PMC - PubMed
    1. Melnick G, O’Leary JF, Zaniello BA, Abrishamian L. COVID-19 driven decline in emergency visits: has it continued, is it permanent, and what does it mean for emergency physicians? Am J Emerg Med. 2022;61:64–7. doi: 10.1016/j.ajem.2022.08.031. - DOI - PMC - PubMed