Skilled home healthcare for discharged COVID-19 patients may lead to better outcomes, faster recovery
the findings of this study suggest that many adverse reactions and persistence of debilitating symptoms can be reduced substantially by providing home healthcare to discharged patients
Literature regarding COVID-19 has been persistently growing since the beginning of the pandemic, most of it guiding healthcare systems and policymakers through this global health crisis. At the beginning of the pandemic, preventive measures to control the spread of the disease and viable treatment protocols to manage the complications arising during the course of the disease were more in focus.
As the pandemic progressed, treatment protocols showed some promise and recovery rates began to rise; the focus shifted slightly to post- COVID-19 recovery and care. The World Health Organisation (WHO) estimated around May 2020 that those with mild COVID-19 may take about two weeks to recover, while severe or critical patients may take three to six weeks.
The continuity of care needed by COVID-19 patients
A study published in Allergy suggests that even mild COVID-19 can cause immunological changes that can lead to some symptoms remaining even after 10 weeks since getting infected. This not only proves that long COVID is real but also highlights the need for continuity of care for COVID-19 patients after they test negative for SARS-CoV-2.
This is not just necessary for patients who have mild COVID-19 disease and did not need to be hospitalised throughout the course of the disease but also needed for patients who were hospitalised, maybe even needed intubation or special care in the intensive care unit (ICU), and were then discharged.
Another study published in the Journal of Infection in August 2020 suggests that follow-up of patients hospitalised due to COVID-19 (including those who needed to be shifted to the ICU) revealed that they had persistent symptoms and may need continued targeted therapy to make a full recovery. The most common persisting symptoms experienced by the participants of this study were fatigue, breathing difficulties, loss of memory, difficulty in concentration and sleep disorders. Patients who stayed in the ICU also experienced higher levels of pain.
Supportive home healthcare for better outcomes
This suggests that patients of COVID-19 who were hospitalised have recovery needs that need to be met so that they can make a full recovery. A new study published in the Annals of Internal Medicine indicates that proper home healthcare may be the perfect option for such patients as their needs can be better met and re-hospitalisations due to complications can also be reduced. The study, conducted by researchers at the University of Pennsylvania School of Nursing, suggests that home healt care that includes skilled nursing and physical therapy can achieve significant improvements in managing prolonged symptoms of COVID-19 patients.
The researchers set out to evaluate the characteristics and outcomes of COVID-19 survivors discharged into home healthcare to see if their recovery needs are being met adequately or not in such settings. The researchers collected data from a not-for-profit home healthcare agency based in the New York City area, which was believed to be the epicentre of the pandemic in the US.
All 1,409 patients included in the study were admitted to one of 64 hospitals in the New York boroughs between April and June 2020 and were discharged with referrals to the home healthcare services. The home care provided to the participants and their recovery were followed up on until September 2020.
The researchers found that after an average of 32 days of home healthcare, 94 percent of the patients achieved statistically significant improvements in symptoms and the ability to perform daily functions like dressing the upper and lower body, bathing, movement and feeding. Dependence on a nurse or family member to perform daily functions decreased significantly over this period too. The risk of rehospitalisation was found to be higher for male patients, those with heart failure during hospitalisation, diabetes, daily pain, two or more emergency department visits in the last six months, severe cognitive impairment or functional dependencies.
At the end of this period, 137 patients had to be rehospitalised and only 11 died, indicating that skilled home healthcare can reduce rehospitalisation and mortality risks. While the full and long impact of COVID-19 disease is still being investigated, the findings of this study suggest that many adverse reactions and persistence of debilitating symptoms can be reduced substantially by providing home healthcare to discharged patients.
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