Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 25, 2023
Date Accepted: Apr 23, 2024
A structured multilevel telehealth service may reduce hospital admissions due to COVID-19 in an under-resourced region in Brazil: a retrospective cohort study.
ABSTRACT
Background:
The pandemic represented a great stimulus for the adoption of telehealth, but data addressing its effectiveness over clinical outcomes are scarce.
Objective:
This study aimed to evaluate the impact of a telehealth service on hospital admission and mortality of patients with flu syndrome in the context of COVID-19 pandemic.
Methods:
A natural experiment was conducted in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-19) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through both a chatbot software or a phone call center; (2) teleconsultations with nurses and medical doctors and (3) a telemonitoring system. It was included patients diagnosed with flu syndrome between June 1st 2020 and May 31th 2021. Sociodemographic, comorbidities and clinical outcomes data were extracted from the Brazilian official databases for Flu Syndrome, Severe Acute Respiratory Syndrome, and Mortality. Models for the clinical outcomes were estimated by logistic regression.
Results:
Results:
The final study population comprised 82,182 adult patients with a valid registry at the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the respiratory illness course, even after adjusting for sociodemographic and underlying medical conditions, (OR=0.82; 95% CI 0.71-0.94; P=.005). No difference in mortality was observed (OR=0.99; 95% CI 0.86-1.12; P=.829).
Conclusions:
A telehealth service applied on a large scale in resource limited region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality. High-quality health care using inexpensive and readily available telehealth and digital health tools can be useful even in places with limited resources and low digital literacy.
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