Optimizing clinical approaches to COVID-19 patients in primary care

Česká verzia

Authors: Bohumil Seifert ¹; Martin Balík ²; Václava Bártů ³; Ludmila Bezdíčková ⁴; Vladimír Černý ⁵; Ivana Čierná-Peterová ⁶; Jozef Čupka ²; Pavel Dlouhý ⁷; David Halata ⁸; Igor Karen ⁹; Petr Kessler ¹⁰; Vladimír Koblížek ¹¹; Norbert Král ¹; Tomáš Kvasnička ¹²; Jan Kvasnička ¹²; Cyril Mucha ¹; Miroslav Penka ¹³; Štěpán Svačina ¹⁴; Jana Šeblová ¹⁵; Martin Špaček ¹⁶; Milan Trojánek ¹⁷
Authors place of work: Ústav všeobecného lékařství 1. LF UK v Praze ¹; Klinika anesteziologie, resuscitace a intenzivni mediciny, 1. LF UK a VFN v Praze ²; Plicní oddělení, Medicon, a. s., Praha ³; Praktický lékař, Praha ⁴; Klinika anesteziologie, perioperační a intenzivní medicíny, UJEP a Masarykovy nemocnice v Ústí nad Labem ⁵; Plicní ambulance, Brandýs nad Labem ⁶; Infekční oddělení, Krajská zdravotní, a. s. – Masarykova, nemocnice v Ústí nad Labem, o. z. ⁷; Praktický lékař, Hošťálková ⁸; Praktický lékař, Benátky nad Jizerou ⁹; Oddělení hematologie a transfuziologie, Nemocnice Pelhřimov ¹⁰; Plicní klinika LF UK a FN Hradec Králové ¹¹; Trombotické centrum, Ústav lékařské biochemie a laboratorní, diagnostiky 1. LF UK a VFN v Praze ¹²; Interní hematologická a onkologická klinika LF MU a FN Brno ¹³; 3. interní klinika – klinika endokrinologie a metabolismu, 1. LF UK a VFN v Praze ¹⁴; Oddělení urgentního příjmu a LSPP dětí, FN Motol, Praha ¹⁵; 1. interní klinika – klinika hematologie 1. LF UK a VFN v Praze ¹⁶; Klinika infekčních nemocí 2. LF UK a FN Na Bulovce, Praha ¹⁷
Published in the journal: Čas. Lék. čes. 2021; 160: 119-125
Category: Original Articles

Summary

There is insufficient evidence from medical studies for clinical approaches to patients with COVID-19 in primary care. Patients often urge the therapeutic use and preventive administration of various medicines, often controlled by studies insufficiently or completely unverified. The aim of the project, commissioned by the Committee of the Society of General Practice of the Czech Medical Association JEP, was to compensate for this deficiency by interdisciplinary consensus and thus provide general practitioners (GPs) with a basic support in accessing patients with COVID-19. Representatives of GPs identified the most common questionable diagnostic or therapeutic approaches and formulated 17 theses, taking into account their own experience, existing Czech and foreign professional recommendations. The RAND/UCLA Appropriateness Method, modified for the needs of pandemic situation, was chosen to seek consensus. Representatives of 7 medical specialties accepted the participation in the 20-member panel. The panel evaluated in 2 rounds, with the comments and opinions of others available to all panelists before the second round. The outcome of the evaluation was agreement on 10 theses addressing the administration of vitamin D, inhaled corticosteroids in patients with COPD and bronchial asthma, acetylsalicylic acid, indications for D-dimer levels examination, preventive administration of LMWH, importance of pulse oximetry, indication for emergency services, indication for antibiotics and rules for distant contact. The panel disagreed on 6 theses recommending the administration of ivermectin, isoprinosine, colchicine and corticosteroids in patients with COVID-19 in primary care. One thesis, taking into account the use of D-dimers in primary care was evaluated as uncertain. The most discussed theses, on which there was also no agreement, were outpatient administration of corticosteroids and the importance of elevation of D-dimers levels or their dynamic increase in a symptomatic patient with COVID-19 as an indication for referral to hospital. The results of the consensus identified topics that need to be further discussed and on which it is appropriate to focus further research.

Keywords:

triage – allocation – scarce resources – ethics – law – recommendations

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Štítky

Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

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