JMIR Publications

ABSTRACT

Background:

Australia has been very successful in controlling the COVID-19 pandemic. Like other developed nations, telehealth has been extensively utilised. Virtual health care, comprising telemedicine combined with remote patient monitoring, has been implemented in selected settings as part of new models of care that aimed to manage patients with COVID-19 outside the hospital setting.

Objective:

To describe the implementation and early experience of virtual health care for community management of patients with COVID-19.

Methods:

Observational cohort study in a large Australian metropolitan health service with established virtual health care program and remote patient monitoring capability. Inclusion criteria were patients with COVID-19 living within the health service who could self-isolate safely, did not require immediate admission to an inpatient setting, had no major active comorbid illness and could be managed at home or other suitable accommodation. Main outcome measures were care escalation rates, including emergency department presentation and hospital admission.

Results:

Between 11-29 March 2020, 162/173 (93.6%) locally-diagnosed patients with COVID-19 were accepted to the virtual health care program, median age 38y (range 11-79). For the 62 patients discharged during this period the median length of stay was 8 days (range 1-17). The peak of 100 prevalent patients equated to approximately 25 patients per Registered Nurse per shift. Patients were contacted a median of 16 times (range 1-30) during this period, with video consultations used 66.3% of the time; 132/162 (81.5%) patients were monitored remotely. Care escalation rates were low: ambulance attendance, 5 (3%); ED attendance, 4 (2.5%); hospital admission, 3 (1.9%). There were no deaths.

Conclusions:

Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian context for pandemic management. Health services implementing virtual health care should anticipate challenges with rapid technology deployments and provide adequate support to resolve them including strategies supporting consumer use of health information technologies.