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Effectiveness of post-COVID-19 primary care attendance in improving survival in very old patients with multimorbidity: a territory-wide target trial emulation.
Wei, Cuiling; Yan, Vincent Ka Chun; Maringe, Camille; Tian, Wenxin; Chu, Rachel Yui Ki; Liu, Wenlong; Liu, Boyan; Hu, Yuqi; Zhou, Lingyue; Chui, Celine Sze Ling; Li, Xue; Wan, Eric Yuk Fai; Cheung, Ching Lung; Chan, Esther Wai Yin; Wong, William Chi Wai; Wong, Ian Chi Kei; Lai, Francisco Tsz Tsun.
Afiliación
  • Wei C; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Yan VKC; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Maringe C; Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
  • Tian W; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Chu RYK; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Liu W; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Liu B; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Hu Y; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Zhou L; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Chui CSL; School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Li X; School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Wan EYF; Laboratory of Data Discovery for Health (D24H), Hong Kong, Hong Kong.
  • Cheung CL; Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, Hong Kong.
  • Chan EWY; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Wong WCW; Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong, Hong Kong.
  • Wong ICK; Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
  • Lai FTT; Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.
Fam Med Community Health ; 12(3)2024 Jul 14.
Article en En | MEDLINE | ID: mdl-39004436
ABSTRACT

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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Multimorbilidad / COVID-19 Límite: Aged80 / Female / Humans / Male País/Región como asunto: Asia Idioma: En Revista: Fam Med Community Health Año: 2024 Tipo del documento: Article País de afiliación: Hong Kong

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Atención Primaria de Salud / Multimorbilidad / COVID-19 Límite: Aged80 / Female / Humans / Male País/Región como asunto: Asia Idioma: En Revista: Fam Med Community Health Año: 2024 Tipo del documento: Article País de afiliación: Hong Kong
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