PRP002: A collaboration between family physicians and public health to provide rapid local data to manage COVID-19 resurgences

Sharon Johnston, MD, LLM


Context: Accurate data about the prevalence of COVID-19 infections is needed to guide our local public health response and inform decisions to re-instate or further ease physical distancing policies. Primary Objective: Determine the prevalence of COVID-19-like symptoms (CLS) in the community and assess if increases in CLS better predict a resurgence in COVID-19 infections than current public health testing methods. Secondary Objective: Assess the uptake of distancing guidelines and the adverse effects and unintended benefits of the COVID-19 crisis on patients and families. Study Design: This observational repeated cross-sectional study will take place in ten community based primary care group practices in Ontario and British Columbia. Intervention: We will deploy the Canadian Primary care Information Network (CPIN) service in family practices to act as COVID-19 sentinels. CPIN is a web-based software system that allows family doctors to send reminders and health advice to their patients by email or text message with links to brief surveys at the end of each message. The patients will be asked to complete a short anonymous questionnaire to indicate if they have any COVID-19 like symptoms, report the number of their close contacts in the past 24 hours and answer a few questions about the impact of the pandemic. We expect to reach 18000 eligible adult patients in each province, with an initial response rate of 50% based on past work, thus a sample of 9000 patients. We will survey groups of 200 patients every ten days. CPIN will daily aggregate the survey responses, producing a picture of the state of COVID-19 by postal region. Primary Outcome Measure: daily prevalence of COVID-19 like symptoms (CLS). Anticipated results: CLS will be an early warning of COVID-19 infection rates in the community. We expect certain segments of Canadian society experience more hardship from physical distancing measures. CPIN will allow Canadians and their family doctors, known colloquially as the eyes and ears of the health system, to be on guard for the nation.
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Roland Grad 11/20/2020

Interesting work! Check out our poster on the "CHARACTERISTICS AND OUTCOMES OF FAMILY PRACTICE PATIENTS WITH COVID-19: A CASE SERIES FROM MONTREAL". Our case series was conducted from March to May. From our findings, we see the need to test a strategy to help patients with COVID-19 avoid unnecessary ED visits. We also see a need for research to evaluate the effect of our proposed strategy, described below. Imagine if early in the disease, a family physician was in phone contact with their sick patients. Then, for confirmed or suspected cases, follow up could be provided (for example) at days 3, 5 and 7 days from symptom onset. Using a pulse oximeter delivered to patients’ homes, remote monitoring could be done as per the UK adult primary care COVID-19 assessment pathway. The purpose of this closer follow up would be to assess for symptoms such as dyspnea at rest, as well as to obtain a measurement of oxygen saturation. For patients without hypoxia, reassurance to remain at home would be indicated. For those with an oxygen saturation of ≤94 percent on room air, an in-person evaluation or admission through the ED would then be warranted.

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