COVID-19 u ordinaciji obiteljske medicine – iskustva i zapažanja tijekom pandemije

Anja Gačina Jazvić, Juraj Jug, Marija Vrca Botica, Ivica Cvetković, Iva Botica, Nives Špoljarić

Uvod: U određenog dijela bolesnika simptomi COVID-19 mogu trajati dulje od četiri tjedna. Većina provedenih istraživanja odnosi se na bolesnike s teškim COVID-19 liječenim u bolničkim uvjetima. Stoga je cilj ovog rada istražiti značajke zbrinjavanja bolesnika s COVID-19 u okviru ordinacija obiteljske medicine te učestalost i karakteristike dugog COVID-a praćenjem u okviru ordinacija obiteljske medicine. Metode: U trima ordinacijama obiteljske medicine na području grada Samobora provedena je retrospektivna analiza elektroničke medicinske dokumentacije pacijenata kojima je u razdoblju od 1. siječnja 2021. do 30. travnja 2022. dijagnosticiran COVID-19 (brzim antigenskim testom [BAT] ili testom lančane reakcije polimerazom [PCR]). Izdvojeni su pacijenti koji su u razdoblju prikupljanja podataka razvili dugi COVID. Praćeni su od postavljanja dijagnoze do 1. travnja 2024. Bilježeni su podatci o vrsti i trajanju simptoma te varijable: težina COVID-19, cijepni status, dob, spol, komorbiditeti, učinjena obrada i propisani lijekovi. Logističkom regresijskom analizom utvrđeni su mogući rizični čimbenici za razvoj dugog COVID-a. Rezultati: U istraživanju je nađeno 1.711 pacijenata s potvrđenim COVID-19, četvrtina svih osiguranika u trima ordinacijama obiteljske medicine uključenim u istraživanje. Pregledano je 39,57% pacijenata, 60,43% ih je savjetovano i praćeno putem telemedicinske konzultacije. Na hitni bolnički prijem upućeno je 5,79% pacijenata, a 3,62% ih je hospitalizirano. Blagi oblik bolesti utvrđen je u 84,92% pacijenata. Antibiotik je propisan u 7,36% pacijenata. Dugi COVID utvrđen je u 5,67% pacijenata. Najčešći simptomi dugog COVID-a bili su respiratorni, opći, kardiovaskularni i neurološki. Dugi COVID češće se javljao u pacijenata s težom kliničkom slikom i endokrinološkim komorbiditetima. Zaključak: Četvrtina osiguranika u trima ordinacijama obiteljske medicine oboljela je od COVID-19, najčešće blagog oblika bolesti koji je najčešće bio liječen simptomatski telemedicinskim konzultacijama bez potrebe za upućivanjem u bolnicu. Dugi COVID, s učestalošću javljanja u 5,67% pacijenata s COVID-19, predstavlja novi izazov u radu liječnika obiteljske medicine.

Introduction: In some patients with COVID-19 symptoms may persist for longer than four weeks. Most research undertaken involved patients with severe COVID-19 treated in hospital environment. The aim of this paper is to explore the characteristics of care for patients with COVID-19 in general practitioner (GP) practices and the prevalence and characteristics of long COVID within the framework of GP. Methods: A retrospective analysis of electronic patient medical records was conducted across three GP practices in the town of Samobor, involving patients diganosed with COVID-19 (detected by a rapid antigen test [RAT] or a polymerase chain reaction [PCR] test) in the period between January 1, 2021 and April 30, 2022. The analysis was further narrowed to the patients who developed long COVID during the data collection period. Those patients were monitored from the point of diagnosis to April 1, 2024. Collected data included the type and duration of symptoms, as well as the following variables: severity of COVID-19, immunization status, age, gender, comorbidities, performed diagnostic procedures and prescribed medications. Logistic regression analysis identified possible risk factors for the onset of long COVID. Results: The research population consisted of 1711 patients with confirmed COVID-19, which is one-quarter of the total number of patients in three GP practices. Thirty-nine point fifty-seven percent of patients were examined in a general practice environment, 60.43% received remote medical consultations. Five point seventy-nine percent of patients were referred to the emergency hospital department, and 3.62% were hospitalized. A mild form of infection was diagnosed in 84.92% of patients. Antibiotic treatment was prescribed to 7.36% of patients. Long COVID was diagnosed in 5.67% of patients. The most common long COVID symptoms were pulmonary, general, cardiovascular and neurological. Long COVID was more prevalent in patients with a severe clinical presentation and endocrine comorbidities. Conclusion: COVID-19 was diagnosed in one-quarter of health insurance beneficiaries from three GP practices. In most cases, the infection was mild, with symptom-based treatment prescribed remotely and without the need for hospital referral. Long COVID, occurring in 5.67% of patients with COVID-19, poses a new challenge in the routine practice of general practitioners.