Teleconsultas para pacientes idosos durante a pandemia de COVID-19: a experiência do programa TeleCOVID-MG

Abstract

Introduction: Telehealth has rapidly expanded during the COVID-19 pandemic to meet social isolation recommendations and teleconsultations were adopted as a new modality of health care. However, the consolidation of this kind of care in a postpandemic context may put part of the population at a disadvantage, including elderly. Thus, knowing the characteristics of the elderly population that may interfere in support provided through telehealth contributes to the development of tools to better fit the necessities of this population. Objectives: This study aimed to describe the socioeconomic, clinical and functional characteristics of elderly patients who were supported by a structured multilevel telehealth program (TeleCOVID-MG program). It also investigated the association of these characteristics with the need for support for carrying out the teleconsultations and with adverse clinical outcomes (hospital admission and mortality within 90 days). Methods: It was an observational retrospective study that included patients aged 60 years or older with confirmed COVID-19 who were supported by the TeleCOVID-MG program between June 2020 and December 2021, in two Brazilian medium-sized municipalities. Data was collected from the electronic records and through structured phone calls interviews. A descriptive analysis of the patients’ characteristics was performed as well as two multivariate analyses for the outcomes need for support for carrying out the teleconsultations and clinical adverse outcomes. Results: 237 patients were included, 121 women (51.1%), mean age 70.8 years (±8.5), 121 (51.1%) had less than 4 years of formal education. Warning clinical signs during the acute phase of COVID-19 were present in 127 patients (53.6%) and 123 patients (51.9%) had two or more comorbidities. Functional decline in activities of daily life was reported by 68 patients (29.0%), cognitive impairment by 20 patients (8.4%) and visual and hearing impairments by 23 (9.7%) and 28 (11.8%) patients. Age greater than 80 years (OR 4.68, 95% CI 1.93 - 11.37, p=0.001), having lower educational level (OR 3.85, 95% CI 1.8 - 8.21, p<0.001) and the presence of hearing (OR 5.46, 95% CI 1.24 - 11.27, p=0.019) and visual (OR 15.10, 95% CI 3.21 - 71.04, p=0.001) impairments were characteristics independently associated with the need for support for carrying out the teleconsultations. The presence of warning signs (OR 5.82, IC 95% 2.59 – 13.06, p<0.001) and the need for support (OR 5.08, 95% CI 2.35 - 10.98, p<0.001) were associated with clinical adverse outcomes. Conclusion: When planning a teleconsultation program to provide health support for elderly patients, a multidimensional evaluation of the patient profile should be included to identify characteristics that may interfere and compromise the effectiveness and the security of remote health care. Telehealth for elderly patients must be equitable, accessible and consider all the physical, cognitive, cultural and socio economics diversities.