A Telemedicine Approach For Assessment, Empowerment And Triage For COVID-19 Patients with Comorbidities

Abstract

Abstract Introduction: COVID-19 pandemic has forced healthcare system to organize the healthcare delivery differently. Methodology: We conducted a retrospective analysis of the Diabetes Wellness Care (DWC) database to understand implications of new virtual clinic model initiated through telemedicine which was extended to manage COVID-19 patients (n=218) Results: 17% of COVID-19 patients were known cases of Type 2 Diabetes (n=37). In these subset of patients, typical COVID-19 pneumonia was present in 45% (n= 17) with 35% (n= 6) requiring hospitalization. COPD/ bronchial asthma pre-existed in 14.5% (n=31) of patients with 3 patients required hospitalization and of which one patient was a known case of diabetes. 11% (n=23) were known hypertensives of which one patient required hospitalization, with coexisting diabetes. 5.5% (n=12) had Coronary Artery Disease and none required hospitalization. 6 patients had concomitant renal impairment. Patients were under strict recommendations to monitor blood glucose and BP by SMBG and Home-Based Blood Pressure Monitoring (HBPM). Doxycycline and ivermectin were prescribed. Azithromycin was added if cough or sore throat was present. Favipiravir was prescribed if elevated CRP and IL-6 with concomitant fever. Pulse oximeter to measure SpO2 was convenient and clinically meaningful during home isolation. X- Ray chest or HRCT scan of chest was mandated including elderly > 60 years. LMWH was utilized only in 2 cases in home isolation (with high D Dimer). 8 patients required hospitalization. Conclusion: Our telemedicine approach enabled a prompt detection of the symptoms, which enabled an effective triage and led to isolation of infectious patients Keywords: Telemedicine, COVID-19, Comorbidities, Diabetes, Hypertension Abbreviations: SMBG- Self Monitoring of Blood Glucose Funding and Conflicts of Interest: None