Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19.
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ABSTRACT:
SUBMITTER: Struyf T
PROVIDER: S-EPMC8407425 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
Publications
Signs and symptoms to determine if a patient presenting in primary care or hospital outpatient settings has COVID-19.
Struyf Thomas T Deeks Jonathan J JJ Dinnes Jacqueline J Takwoingi Yemisi Y Davenport Clare C Leeflang Mariska Mg MM Spijker René R Hooft Lotty L Emperador Devy D Domen Julie J Horn Sebastiaan R A SRA Van den Bruel Ann A
The Cochrane database of systematic reviews 20210223
<h4>Background</h4>The clinical implications of SARS-CoV-2 infection are highly variable. Some people with SARS-CoV-2 infection remain asymptomatic, whilst the infection can cause mild to moderate COVID-19 and COVID-19 pneumonia in others. This can lead to some people requiring intensive care support and, in some cases, to death, especially in older adults. Symptoms such as fever, cough, or loss of smell or taste, and signs such as oxygen saturation are the first and most readily available diagn ...[more]
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Project description:ObjectiveTo determine whether neighbours who share the same family physicians have better cardiovascular and health care outcomes.DesignRetrospective cohort study using administrative health databases.SettingOntario.ParticipantsThe study population included 2,690,482 adult patients cared for by 1710 family physicians.InterventionsAdult residents of Ontario were linked to their family physicians and the geographic distance between patients in the same panel or list was calculated. Using distance between patients within a panel to stratify physicians into quintiles of panel proximity, physicians and patients from close-proximity practices were compared with those from more-distant-proximity practices. Age- and sex-standardized incidence rates and hazard ratios from cause-specific hazards regression models were determined.Main outcome measuresThe occurrence of a major cardiovascular event during a 5-year follow-up period (2008 to 2012).ResultsPatients of panels in the closest-proximity quintile lived an average of 3.9 km from the 10 closest patients in their panel compared with 12.4 km for the 10 closest patients of panels in the distant-proximity quintile. After adjusting for various patient and physician characteristics, patients in the most-distant-proximity practices had a 24% higher rate of cardiovascular events (adjusted hazard ratio=1.24 [95% CI 1.20 to 1.28], P<.001) than patients in the closest-proximity practices. Age- and sex-standardized all-cause mortality and total per patient health care costs were also lowest in the closest-proximity quintile. In sensitivity analyses restricted to large urban communities and to White long-term residents, results were similar.ConclusionThe better cardiovascular outcomes observed in close-proximity panels may be related to a previously unrecognized mechanism of social connectedness that extends the effectiveness of primary care practitioners.
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