COVID-19 driven care changes in high risk patients from an outpatient to a community setting
A cross-sectional study
Abstract
Abstract. Background: COVID-19 has led to a change in care for patients with chronic conditions, involving a transfer of drug administration from an outpatient to a community setting. Aim: To investigate patient preferences for treatment settings in the light of the current pandemic. Methods: Patients, who prior to the pandemic had attended two different outpatient clinics in a university hospital for their infusions or injections, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. Results: Out of 49 patients with either anti-inflammatory or immunoglobulin treatments (response rate: 83 %), 24 (49.0 %) switched from subcutaneous (sc) injections in the hospital to the community setting, 18 (36.7 %) from intravenous infusions (iv) in the hospital to sc administration at home and 7 (14.3 %) moved to iv at home. During the pandemic 38 (80.9 %) wanted to continue their treatment at home, but after the pandemic 22 (46.8 %) would opt to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team, had increased concerns about safety as a result of COVID-19. Conclusions: The experience during the COVID-19 pandemic has increased self-management-skills in some patients, but long-term follow-up is needed. It has repercussions for future shared decision making for patients and their healthcare teams.
Zusammenfassung. Hintergrund: COVID-19 hat zu einer Veränderung der Versorgung von Patient_innen mit chronischen Erkrankungen geführt, inklusive Verlagerung der Medikamentenapplikation aus dem Spital in die häusliche Umgebung. Ziel: Untersuchung der Präferenzen für den Behandlungsort im Licht der aktuellen Pandemie. Methoden: Halbstrukturierte Telefoninterviews mit Patient_innen, die vor der Pandemie ihre Infusionen oder Injektionen in zwei Ambulatorien eines Universitätsspitals erhalten hatten. Datenanalyse mit qualitativen und quantitativen Methoden. Ergebnisse: Von 49 Patient_innen mit antiinflammatorischer oder Immunglobulin-Therapie (Teilnahmequote: 83 %) wechselten 24 (49,0 %) von Subkutaninjektionen (s. c.) im Spital zum häuslichen Setting, 18 (36,7 %) von Infusionen (i. v.) im Spital zu s.c.-Injektionen zu Hause und 7 (14,3 %) erhielten Infusionen zu Hause. Während der Pandemie wollten 38 (80,9 %) ihre Behandlung zu Hause fortführen. Nach der Pandemie würden sich jedoch 22 (46,8 %) für eine Rückkehr ins Spital entscheiden. Die Zufriedenheit war für beide Settings hoch, mit einer leichten Tendenz zugunsten des Spitals. Die qualitativen Daten zeigen, dass Patient_innen wegen COVID-19 verstärkt Sicherheitsbedenken haben und gleichzeitig die Wichtigkeit der Beziehung zum Behandlungsteam hervorheben. Schlussfolgerungen: Die Erfahrung während der COVID-19-Pandemie hat Selbstmanagementskills einiger Patient_innen gefördert, es wird jedoch ein Langzeit-Follow-Up benötigt. Sie hat Auswirkungen auf zukünftige gemeinsame Entscheidungen von Patient_innen und deren Behandlungsteams.
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