Artikel
Characterization of patients in the ambulatory care setting in Germany with post-acute sequelae of SARS-CoV-2 infection
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Autoren
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Mandy Schulz
- Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany
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Sandra Mangiapane
- Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany
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Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO center, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
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Thomas Czihal
- Central Research Institute for Ambulatory Health Care in Germany, Berlin, Germany
| Veröffentlicht: | 30. September 2022 |
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Gliederung
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Background and status of (inter)national research: Long-term health limitations after COVID-19 disease, also known as post-acute sequelae of SARS-CoV-2 infection are of major public health and medical care concern.
Research question and objective: The present study aims on characterization of post COVID-19 patients with respect to utilization of outpatient medical service.
Method or hypothesis: Based on statutory health insurance (SHI) billing data, we performed a case-control study with cases being all patients with valid information on age (0–109 years), sex (male/female), and place of residence, for whom the assured post COVID-19 code (U09.9!) was assigned in the second quarter of 2021 (hereafter referred to as Q2 2021) (n=160,663). The control group forms a random sample of all patients treated in Q2 2021 without post-COVID-19 code and COVID-19 disease (i.e. generally treated population) at a ratio of 1:2. Logistic regression analysis was performed to model the association between the presence of pre-existing conditions and the likelihood of post COVID-19 and the association between the presence of post COVID-19 and the utilization of specific outpatient services.
Results: In Q2 2021, post COVID-19 patients generated nearly twice as many treatments in SHI physician practices (treatment cases) than controls (4.3 vs. 2.6). Among cases, medical care for post COVID-19 accounted for about one quarter of total treatment cases. Cases and controls also differed with respect to utilization of primary and specialist’s care. After adjustment for age, sex and preexisting morbidity, symptom-specific consultations conducted by primary care physicians (OR 1.96, 95% CI 1.93-1.98) and telephone consultations (OR 2.09, 95% CI 2.05-2.13) were more frequently billed for cases than for controls, as was treatment by pulmonologists (OR 5.23 95% CI 5.09-5.38) and cardiologists (OR 1.22, 95% CI 1.18-1.26) and the prescription of rehabilitation (OR 6.88, 95% CI 6.00-7.90), though this proportion was relatively small (0.6% cases vs. 0.1% of controls).
Discussion: By examining the utilization of ambulatory care contract physician services, this study adds new insights into the treatment care of post-COVID-19. However, since the present study is based on billing data for the 2nd quarter of 2021 and thus describes a situation based on a largely unvaccinated population and the consequence of the "wild-type/alpha wave", an extrapolation to subsequent waves with higher population immunity remains to be investigated.
Practical implications: Primary care physicians provide a significant amount of care to patients, especially by means of time-intensive consultations such as the symptom-oriented conversation. Further, a significant proportion of patients required specialist care by pulmonologists and cardiologists, which could be an indication of the particular severity of the disease.
Appeal for practice (science and/or care) in one sentence: Future studies should quantify the increased need for consultation and coordination in the treatment of patients with post-COVID-19, taking into account the guidelines.
