Optimizing clinical approaches to COVID-19 patients in primary care
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‘ workplace:
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:
Čas. Lék. čes. 2021; 160: 119-125
Category:
Original Articles
Overview
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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Journal of Czech Physicians
2021 Issue 4
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