Medicalization of nursing facilities as a real alternative to hospitalization during the COVID-19 pandemic
e202011151
Keywords:
COVID-19, Nursing home, Socio-sanitary institution, Medicalization, MortalityAbstract
Background: Nursing homes are high-risk environments for the transmission of the SARS-CoV-2 coronavirus, as they are a closed environment, with patients who present atypical manifestations of the disease, high risk of unfavorable evolution, and staff who frequently present a high mobility in relation to their jobs. On the other hand, in a pandemic situation, numerous hospitals have suffered periods of great healthcare pressure. The objective of this work was to present an experience of medicalization of a residence where almost 50% of the residents contracted the disease.
Methods: A multidisciplinary intervention was carried out in a publicly owned nursing home with 99 residents. Specialists from Internal Medicine, Primary Care and health technicians worked together, in close collaboration with the residence workers. The presence of nursing personnel 24 hours a day and medical personnel with daily visits was enabled. The center was provided with the necessary means to administer the medication (oral and intravenous) and oxygen therapy necessary to care for patients with the disease. Analytical results were available within 24 hours. For data analysis, the percentages were calculated and the mean was used as a measure of central tendency.
Results: Forty-eight residents (48.5%) and fifteen workers contracted the disease. The total number of deaths during that period was thirteen (13.1%), seven of them diagnosed with COVID-19 (mean age 84.4 years), with a fatality rate of 14.6%. Eleven patients (22%) diagnosed with COVID-19 were hospitalized, two of whom died during admission.
Conclusions: The medicalization of nursing homes can help to reduce the pressure on care in hospitals and optimize care for these vulnerable people with more humanized care, which can ultimately lead to better health outcomes.
Downloads
References
Dae-Gyun A, Hye-Jin S, Mi-Hwa K, Sunhee L, Hae-Soo K, Jinjong M et al. Current status of epidemiology, diagnosis, therapeutics, and vaccines for novel coronavirus disease 2019 (COVID-19). J Microbiol Biotechnol. 2020;30:313-24.
McMichael TM, Currie DW, Clark S, Kay M, Lewis J, Baer A. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382:2005-11.
CDC Public Health Emergency Team, Danis K, Fonteneau L, Scarlett Georges S, Daniau C et al. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA. Eurosurveillance 2020; 25: 04.
Shi SM, Bakaev I, Chen H, Travison TG, Berry SD. Risk Factors, Presentation, and Course of Coronavirus Disease 2019 in a Large, Academic Long-Term Care Facility. J Am Med Dir Assoc 2020 21:1378-1383.e1
Taylor J, Carter RJ, Lehnertz N, Kazazian L, Sullivan M, Wang X et al. Serial Testing for SARS-CoV-2 and Virus Whole Genome Sequencing Inform Infection Risk at Two Skilled Nursing Facilities with COVID-19 Outbreaks - Minnesota, April-June 2020. MMWR Morb Mortal Wkly Rep. 2020;69:1288-1295.
D’Adamo H, Yoshikawa T, Ouslander JG. Coronavirus Disease 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19. J Am Geriatr Soc. 2020;68:912-17.
Instrucción Nº 2/2020 de la Viceconsejería de Salud y Familias para ordenar las actuaciones de obligado cumplimiento relativas a la dirección, gestión e inspección de los centros residenciales de mayores durante la pandemia Covid-19. Fecha 18.09.2020.
Plan de respuesta temprana en un escenario de control de la pandemia por Covid-19. Ministerio de Sanidad, Consumo y Bienestar Social. Disponible en: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Plan_de_respuesta_temprana_escenario_control.pdf. (Acceso 11.10.2020).
Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489-95.
Informe semanal ALERTA COVID19 Andalucía. Dirección General de Salud Pública y Ordenación Farmacéutica. 8 de mayo de 2020. Junta de Andalucía.
Pericàs JM, Cucchiari D, Torrallardona-Murphy O, Calvo J, Serralabós J, Alvés E et al. Hospital at home for the management of COVID-19: preliminary experience with 63 patients. Infection. 2020; 29:1-6.
Inzitari M, Udina C, Len O, Ars J, Arnal C, Badani H et al. How a Barcelona Post-Acute Facility became a Referral Center for Comprehensive Management of Subacute Patients with COVID-19. J Am Med Dir Assoc. 2020;2:954-957.
Day HR, Perencevich EN, Harris AD, Himelhoch SS, Brown CH, Gruber-Baldini AL et al. Do contact precautions cause depression? A two-year study at a tertiary care medical centre. J Hosp Infect. 2011;79:103-7.
Morgan DJ, Diekema DJ, Sepkowitz K, Perencevich EN. Adverse outcomes associated with contact precautions: a review of the literature. Am J Infect Control. 2009;37:85–93.
Evans HL, Shaffer MM, Hughes MG, Smith RL, Chong TW, Raymond DP et al. Contact isolation in surgical patients: a barrier to care? Surgery. 2003;134:180-8.
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2020 Joaquín Salas-Coronas, Mª Ángeles García-Jerez, Javier Luis Sandoval-Codoni, Carmen María Lara-Rojas, Javier Gamir Ruiz, María Jesús Sanabria-Medina, María del Carmen Cortés-González, Silvia Vallejo-Godoy, Ignacio Aguilar-Martín, Enriqueta Quesada-Yañez, Mª Ángeles Martín-Linares, María Luisa Álvarez-Moreno
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Usted es libre de:
Compartir — copiar y redistribuir el material en cualquier medio o formato.
La licenciante no puede revocar estas libertades en tanto usted siga los términos de la licencia.
Bajo los siguientes términos:
Atribución — Usted debe dar crédito de manera adecuada , brindar un enlace a la licencia, e indicar si se han realizado cambios. Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugiera que usted o su uso tienen el apoyo de la licenciante.
NoComercial — Usted no puede hacer uso del material con propósitos comerciales.
SinDerivadas — Si remezcla, transforma o crea a partir del material, no podrá distribuir el material modificado.
No hay restricciones adicionales — No puede aplicar términos legales ni medidas tecnológicas que restrinjan legalmente a otras a hacer cualquier uso permitido por la licencia.
Avisos:
No tiene que cumplir con la licencia para elementos del material en el dominio público o cuando su uso esté permitido por una excepción o limitación aplicable.
No se dan garantías. La licencia podría no darle todos los permisos que necesita para el uso que tenga previsto. Por ejemplo, otros derechos como publicidad, privacidad, o derechos morales pueden limitar la forma en que utilice el material.
