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COVID-19 research briefs: (3) Guidance for remote (telehealth) management (25 March 2020)
Clinical Question
How should primary care clinicians remotely manage patients with acute respiratory tract symptoms and possible infection with the novel coronavirus disease 2019 (COVID-19)?
Bottom line
Converting to assessment and management via telephone or video takes a little planning and a change in approach, both of which are addressed in this article. The article includes a useful infographic that it will be updated as new information is revealed, so check back often. 5
Reference
Study design: Practice guideline
Funding: Self-funded or unfunded
Setting: Outpatient (primary care)
Synopsis
Research Brief #3 (Greenhalgh, 2020) NOTE: This POEM describes the version of the article published 25 March 2020, but the article will be updated as new information becomes available, so check back often for changes, and print out each latest infographic at the end of the article as a quick guide. This expert-based review offers best practices for how to set up remote care via telephone or video and how to assess patients with possible COVID-19 infection. To get started, assure you have remote access to patient records and, if using video, that your equipment works. Take a history, starting with broad questions of the patient's state of health to determine why he or she has decided to seek care now. Assess for cough and degree of breathlessness using general questions and probing for recent change. Ask for a history of contact with a confirmed or presumed patient with infection. Ask about any comorbidities that might increase risk. Probe for red flag symptoms that warrant more urgent assessment, including temperature higher than 38 degrees, respiratory rate greater than 20, heart rate more than 100 with new confusion, or, if available, an oxygen saturation less than 95%. Otherwise, recommend home management. Assess the availability of someone to monitor the patient at home and arrange for further follow-up. Call for immediate transport (911, 999, or your specific country code) if the patient needs to be admitted.
Reviewer
Allen F. Shaughnessy, PharmD, MMedEd
Professor of Family Medicine
Tufts University
Boston, MA