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Milani C, Buscemi P, Velpini B, Naldini G, Cosma C, Giannuzzi F, Ionita G, Monaci P, Landi R, Pontalti I, Baggiani L, Nerattini M, Lorini C, Bonaccorsi G. The Activity of Special Continuity Care Units in the City of Florence During the COVID-19 Pandemic. Int J Public Health 2023; 68:1606338. [PMID: 37867562 PMCID: PMC10587394 DOI: 10.3389/ijph.2023.1606338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Objectives: Worldwide, countries adopted different strategies in primary care (PC) to cope with the COVID-19 pandemic. This study aims to describe and evaluate the functions and activity load of a specific PC organizational model called "Special Continuity Care Units" (SCCU) in Florence, Italy, and to investigate the characteristics of the COVID-19 patients assisted by the service. Methods: The retrospective cross-sectional design used daily updated reports by SCCU team members to evaluate the activity load. The retrospective cohort study analyzed data of the demographics, clinical characteristics, and process outcomes of patients assisted during the second pandemic wave. Results: The analysis shows how the service activity load changed along with the epidemiological trend. Regarding people assisted by the SCCU, the median follow-up duration of symptoms was 6 days; male gender and being symptomatic were predictors of hospitalization. Conclusion: Some key characteristics can be described as indispensable in PC services facing health emergencies: model flexibility, the availability of resources, networking among services to enhance coordination and resource optimization, and close collaboration with general practitioners.
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Affiliation(s)
- Chiara Milani
- Department of Health Science, University of Florence, Florence, Italy
| | - Primo Buscemi
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Beatrice Velpini
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giulia Naldini
- Department of District Health Care Network, Azienda USL Toscana Centro, Florence, Italy
| | - Claudia Cosma
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Francesco Giannuzzi
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Giulia Ionita
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Pietro Monaci
- School of Specialization in Hygiene and Preventive Medicine, University of Florence, Florence, Italy
| | - Ruggero Landi
- Ex-Special Continuity Care Units, Azienda USL Toscana Centro, Florence, Italy
| | - Irene Pontalti
- Ex-Special Continuity Care Units, Azienda USL Toscana Centro, Florence, Italy
| | - Lorenzo Baggiani
- Department of District Health Care Network, Azienda USL Toscana Centro, Florence, Italy
| | | | - Chiara Lorini
- Department of Health Science, University of Florence, Florence, Italy
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Ding Y, Xu C, Zhang X, He Y, Wang F, Zhang L, Yu Y, Zhou Y, Zhang Y, Ye D. The role of closed-loop management of fever patients in a county-level medical community for the prevention and control of the post-coronavirus disease 2019 pandemic. Medicine (Baltimore) 2023; 102:e32690. [PMID: 36701725 PMCID: PMC9857253 DOI: 10.1097/md.0000000000032690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We built a closed-loop management model for patients with fever in a county-level medical community and explored the role of this model in post-coronavirus disease 2019 (COVID-19) epidemic prevention and control. The subjects included 83,791 patients with fever treated in designated hospitals between February 2020 and April 2021. A pre-hospital, in-hospital, and post-hospital management system for patients with fever in the county-level medical community was established to allow the closed-loop management of these patients. SPSS software (version 13.0) was used to analyze the methods of visiting the hospital, nucleic acid detection in the hospital, and location of the patients after the hospital visit. Chi-square tests were used to compare the methods of visiting and location after hospital visits between patients with and without an epidemiological history. The number of patients with fever in the fever clinic showed a logarithm change (R2 = 0.4710), accompanied by seasonal changes. The number of fever patients with an epidemiological history decreased logarithmically monthly (R2 = 0.8876). Among patients with fever, 99.64% sought medical treatment on their own, with relatively low proportions undergoing home quarantine and requiring centralized quarantine special vehicles. After visiting the fever clinics, 98.56% of patients isolated at home or were monitored, with small proportions of patients requiring hospital admission or centralized isolation. However, the proportions of patients with home and centralized isolation with epidemiology were relatively high, accounting for 20.55% and 27.40% of cases, respectively. Compared to the overall population of patients with fever, the difference was statistically significant (χ2 = 48.881, P = .000). The establishment of a closed-loop management model for patients with fever in a county-level medical community strengthened the management of these patients. No local cases occurred in Beilun District between March 2020 and April 2021. In the post-COVID-19 era, all medical institutions in the county-level medical community strengthened infectious disease pre-examination and triage and promoted the formation of a strategic pattern of initial diagnosis at the grassroots level, 2-way referral, upper and lower linkage, and joint epidemic prevention. This management was more conducive to COVID prevention and control by hierarchical management according to the presence or absence of an epidemiological history.
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Affiliation(s)
- Yajun Ding
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Chunxia Xu
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Xingguo Zhang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Yanzhen He
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Fang Wang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Libo Zhang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Yaner Yu
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Yachun Zhou
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Youping Zhang
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
| | - Dongxian Ye
- Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang, PR China
- * Correspondence: Dongxian Ye, Department of Prevention and Health Care, Beilun Branch of the First Affiliated Hospital, College of Medicine, Zhejiang University, Ningbo, Zhejiang 315800, PR China (e-mail: )
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Tulledge-Scheitel SM, Billings TA, Fischer KM, Homme JH, Miller JM, North F, Sanderson RL, Schroeder DR, Vaughan MA, Croghan IT. COVID-19 Care Clinic in a Medical Center: Lessons Learned. J Prim Care Community Health 2021; 12:21501327211056796. [PMID: 34872410 PMCID: PMC8655436 DOI: 10.1177/21501327211056796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The purpose of this report is to describe the elements of a Covid-19 Care Clinic (CCC), patient demographics, and outcomes. METHODS Descriptive statistics were used to describe demographics, clinical characteristics, and outcomes. This report is based on 4934 unique patients seen in the CCC who provided research authorization within a 10-month period of time (April 1, 2020-January 31, 2021). The CCC infection control processes consisted of a rooming process that mitigated SARS-COV-2 transmission, preparing examination rooms, using PPE by staff, in room lab drawing, and escorting services to minimize the time in clinic. RESULTS Of the 4934 unique patients seen (age range newborn-102 years), 76.8% were tested for COVID-19. Of those tested, 11.8% were positive for SARS-CoV-2. Ninety-two percent of the patients with the reason for the visit documented had COVID-19 type symptoms. Cough, shortness of breath, and chest pain were the most common presenting symptom in those with COVID-19. At the time of the visit in the CCC, 5.8% of the patients were actively contagious. Thirty days after being seen in the CCC, 9.1% of the patients were seen in the emergency department (ED) and 0.2% died. During the 10-month period there were no known occupationally related COVID-19 infections. CONCLUSION The COVID-19 Care Clinic provided face-to-face access for all ages with COVID-19 type symptoms. A minority of patients had COVID-19 who were seen in the clinic. The clinic provided an additional venue of care outside of the ED. The infectious control measures employed were highly effective in protecting the staff. Lessons learned allow for decentralization of COVID-19 symptom care to the primary care practices employing the infection control measures.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ivana T Croghan
- Mayo Clinic, Rochester, MN, USA.,Mayo Clinic, Kasson, MN, USA
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