Abstract
Introduction: In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people (both patients and health professionals), and reduce the risk of infection. Objective: To adapt and validate the use of a smartphone application for outpatient follow-up of COVID-19 patients after hospital discharge. Methods: We conducted an open-label clinical trial at Hospital Universitari Vall d’Hebron in Barcelona, Spain. Patients were randomly assigned in a 1:1 ratio to be followed by the Farmalarm app or by their primary care center. The primary endpoint was the reduction in the need for in-person return visits. Results: From 31 March to 4 May 2020, 150 patients were enrolled in the study at hospital discharge: 74 patients were randomized to the experimental group, and 76 to the control group. All patients in the control group and all except for six in the experimental group completed the study. During hospitalization, before study inclusion, all but 4 (97.3%) had viral pneumonia, 91 (60.7%) required supplemental oxygen, and 16 (10.7%) required intensive care unit (ICU) admission. COVID-19–related return visits to the emergency department were significantly higher in the control group (7.9% vs. 0%; p = 0.028) in the per-protocol analysis. Telephone consultations with the emergency department were performed by 12 (15.8%) patients in the control group and 0 (0%) in the experimental group (p < 0.001). Satisfaction with outpatient monitoring was rated higher by the experimental group (5 vs. 4 points; p < 0.001). Conclusions: Following COVID-19 hospital discharge, home follow-up via a mobile app was effective in reducing in-person return visits without undermining patient satisfaction or perception of health, compared with standard follow-up.
Highlights
In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people, and reduce the risk of infection
The first COVID-19 was diagnosed in Spain on January 31 2020, and just like in the rest of the world, it exponentially increased in months [2]
We conducted the COVID-19 Follow-App trial, a single-center, open-label, randomized clinical trial at Hospital Universitari Vall d’Hebron, a 1100-bed teaching hospital in Patients were eligible if they met the following inclusion criteria: aged 18 years or older; availability of a mobile device, such as a smartphone or a tablet with internet connectivity; and hospital discharge after admission for COVID-19 diagnosed by real-time polymerase chain reaction (RT-PCR)
Summary
In the midst of a pandemic, apps can be used to provide close follow-up, ensure that patients are monitored at home, avoid excessive pressure on medical facilities, prevent the movement of people (both patients and health professionals), and reduce the risk of infection. Thanks to the efforts of clinicians and the scientific community, the clinical characteristics of patients with coronavirus disease (COVID-19) were early described, with most presenting mild symptoms, and progression to SARS in over 25 to 30% of patients with pneumonia [3,4,5,6,7]. It caused a therapeutic challenge for health workers due to the complete absence of evidence about its management, doubts about contagiousness, and uncertainty about patients’ evolution and the potential complications appearing on discharge, inherent in new diseases. Ambulatory monitoring of such a high volume of patients was unaffordable at the time, so once patients were discharged, the system was unable to guarantee an adequate follow-up
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