THE CONTINUITY OF HEALTH ASSISTANCE TO PATIENTS POST HOSPITALIZATION DUE TO COVID-19: PRELIMINARY RESULTS OF A COHORT STUDY

A.C. Gambeta¹, É.C.G. Silva¹, C.G. Godoy¹, D.B. Oliveira¹, C.R.F. Carvalho¹, E.M. Silva¹, C.M. Campos¹, C. Fu¹, J.E. Pompeu¹, D.S. Schujmann¹, C. Tanaka¹, C. Toufen Junior², L. Oliveira³, L. Cassimiro³, J.M. Silva¹, M.D. Santos¹, G. Correa², C. Carvalho², A.C.B. Schmitt¹

Background: Together, severe COVID-19 and long hospital stays impair structures and functions of the body which are fundamental for daily live activities. As it is a relatively new disease, few studies assessing the impact of COVID-19 add up to the deleterious effects of hospitalization in the functionality after hospital discharge in adults and older people, as well the long term effects and the real necessity of assistance.

Purpose: To describe the continuity of assistance to patients who have been hospitalized due to COVID-19, as well their perceptions about the necessity of physical rehabilitation.

Methods: This was a prospective cohort study that will follow up 400 adults and older people during one year. To date, we evaluated 49 patients, both genders, after a long stay at a high complexity hospital in Brazil (Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo) due severe COVID-19. We applied a questionnaire about the orientations to continue caring for their health after the hospitalization at the moment of discharge, including their current perception about the necessity of physical rehabilitation and their complaint about that. Patients were recruited 30-45 days after hospital discharge. The descriptives analyses were performed using the JASP software.

Results: We assessed 49 patients (mean age 57.81(11.2) years), 27 had been directed to a health service to follow their health conditions and 22 did not receive any orientation relation to that at the moment of discharge. The sample which had received the forward comprehend 13 women (48.14%) and 14 men (51.85%), 37% of them didn’t complete middle school, 33% finished high school and 14% finished middle school and graduated. On the other hand, 9 women (40.9%) and 13 men (59.0%) did not receive any orientation, as well 59.0% of them didn’t complete middle school against 18.1% who finished, 13.6% finished high school and 9% graduated. When we asked the patients about their necessity for rehabilitation, 72.7% believed that they needed physiotherapy but did not receive any orientation. 44.4% of the patients who needed physiotherapy didn’t receive forward, 22.2% were forward to primary health care, 19.4% were forward to their own service and 11.1% were directed to a middle complexity health service. About the complaints, 41.6% need physiotherapy because of lower limbs weakness, 30.5% because of dyspnoea 27.7% because of upper limbs weakness, 27% because of fatigue and 11.1% because of pain. To finish, the patients who have a necessity for physiotherapy, just 55.5% had access to that.

Conclusion(s): Our partial results showed that there is not a protocol to determine who will receive orientations about the continuity of health assistance.

Implications: Our study can contribute to developing strategies to identify the patients who need more attention related to their health and to promote the real continuity of health assistance. It is important to understand the impact of severe COVID-19 on functional prognosis after discharge to develop rehabilitation strategies, specifically to minimize the negative effects on muscle strength, fatigue, mobility and respiratory function.

Funding, acknowledgements: Fundação de Amparo à Pesquisa do Estado de São Paulo(FAPESP-2018/19618-8) and Conselho Nacional de Desenvolvimento Científico e Tecnológico(CNPq- 402698/2020-7)

Keywords: Health Care, Coronavirus, Hospitalization

Topic: COVID-19

Did this work require ethics approval? Yes

Institution: Medical School of the University of São Paulo, Brazil

Committee: Hospital das Clinicas - Medical School - University of São Paulo

Ethics number: 34115720.5.0000.0068