key: cord-1024539-edf2wwig authors: Fadaizadeh, Lida; Jamaati, Hamidreza; Varahram, Mohammad; Taheri, Mohammad Jafar; Sanaat, Mohammad title: Follow-Up of Coronavirus Infected Patients Using Telemedicine in a Referral Pulmonary Center date: 2020-12-03 journal: Tanaffos DOI: nan sha: 5e3e1bc074cdc8c64bf5acb2c527405b731e36c8 doc_id: 1024539 cord_uid: edf2wwig BACKGROUND: Telemedicine is considered an innovative approach for management and follow up of communicable diseases, when person to person contact has the risk of disease dissemination, such as the situation being experienced with corona virus infection. The aim of this study was to evaluate the role of telemedicine in patient follow-up and patient compliance in different communication methods. MATERIALS AND METHODS: All patients discharged from a referral pulmonary hospital dedicated to coronavirus infected patients were given instructions on follow-up of symptoms. One group received messages via short message system regarding the severity of their symptoms. For the other group a mobile application was specially designed for tracking their well-being on a daily basis. Severity of symptoms and course of disease were monitored in each group for a two-month period. RESULTS: A total 1091 patients with mean age of 53.96± 17.95 years were enrolled in the study. In the first group 406 (60.14%) messages were successfully sent, from which 150 (36.94%) patients replied. Also, 243(35%) patients contacted us by making phone calls. Of the total patients in the second group, 153(64%) patients started using the mobile application. Chief complaint of patients was mainly cough, shortness of breath, fatigue, and myalgia. Deep vein thrombosis, hyperglycemia, post kidney transplant patient and bloody diarrhea were among the reported cases. CONCLUSION: Patient follow-up during epidemics, especially when the disease course is unknown, is an important step in both successful patient management and disease control. This study showed the role of telemedicine for patient follow-up, mostly in detecting special situations. But, in order to be successful patient education and active follow-up are important factors that must be considered. Telemedicine improves access to medical services via telecommunication and it is an innovative approach for managing patients with communicable diseases. As its name indicates, medical care can be given to patients from long distance using communication devices especially when visiting hospitals have the risk of getting infected and also the risk of infecting others, similar to the situation now in corona virus pandemic. This system also reduces the burden on the healthcare system, helps triage patients, direct the symptomatic ones to medical centers for management, and follow the suspected ones on a routine TANAFFOS Fadaizadeh L, et al. 357 Tanaffos 2020; 19 (4) : [356] [357] [358] [359] [360] [361] [362] [363] basis; therefore, save the medical facilities for those seriously ill. During the previous epidemics, telemedicine has had a leading role in patient management (1) . Many patients have been visited, consulted, prescribed, and also followed during SARS, MERS, and Ebola and many other viral outbreaks (2) (3) (4) 6) . Also, China's success in slowing and controlling corona virus transmission in the present outbreak has been partly due to increasing virtual visits (5, 7) . Most recent recommendations by authorities around the world have also emphasized on using telemedicine as a screening tool and that special arrangements must be made to facilitate its process (8, 9) . Most of the previous experiences considering the use of telemedicine in epidemics has been to help select patients needing hospital care and keeping the suspected ones at home, which is the strategy being implemented in most countries infected with corona virus (10) (11) (12) . But considering the fact that the disease course is still unknown and many of its features still needs to be clarified, especially reinfection and late complications, patient follow-up after discharge is an important issue that must be taken into consideration. This cross-sectional study was performed on all patients discharged from one of the leading and referral hospitals for corona virus infected patients, during a four-month period. Two different means of telecommunication were used for follow-up. During the first two months a short message service (SMS) panel which was prepared for sending bulk messages to all patients was used along with an application for sending daily recommendations. During the second two months a mobile application specially designed for these patients was used for follow-up and communication. All patients were given instructions regarding the use of each of these methods on the day of discharge. The patients in the first group were given hard copies of the instructions for SMS contacts and installation of application. For the second group a phone contact was made the day after discharge and oral instructions were given for communication and application installation. Also, the patients were free to make phone calls for any questions they had, any time of the day. It is worth mentioning that these patients were all positive for corona virus and that their medication had been started but not completed during their admission, and after initial management, they were sent home with drug prescriptions. Therefore, all patients needed to be followed to monitor the course of their illness. The short message service (SMS), which was sent from the first day after discharge contained the following questions: Have you experienced aggravation of: 1-fever, 2cough, 3-dyspnea, 4-chest pain, 5-diarrhea, 6-myalgia,7anorexia and fatigue, 8 -none. The patient would either reply by sending the number relating to one or more of the symptoms or they were free to call and talk about their problem. If the response by SMS was positive to any of the symptoms, the patients were actively contacted and further instructions were given accordingly. Each patient had a separate file and daily reports were registered during the study period. Patients were also asked to install an application for the purpose of receiving recommendations related to their status on a daily basis. The interesting feature of this application was the main reason it was chosen. Each day a recommendation or an informative message was sent to each patient regarding their illness, which helped them take better care of themselves. The topic of these messages was chosen by the patients and they were renewed regularly. Some of these topics were information about diet and supplements, exercise and physical activities, stress management, information on corona virus infection and its control, personal hygiene, and many other useful topics. For the second part of follow up a mobile application which could be installed on android smart phones was specially designed for these patients. Some features of this application were: First, a notification was sent every other day on a regular time to ask about their symptoms. Second, a special chat section was designed for the patients to contact their physician and ask questions. Third, the patients were able to send images, such as chest x rays or CT scans, if required. The symptoms include fever, cough, dyspnea, chest pain, diarrhea, myalgia, anorexia, and fatigue which the patients were asked to report on a regular basis. Also the patients were free to make phone calls any time they had problem or question. During a four-month period, 1091 patients who were discharged from hospital were enrolled in our study. intensive care management (18) , and rehabilitation (19) . As an example, during Ebola disease outbreak specially designed applications were used for patient detection and follow-up, with significant results (1,3) . As a new branch of science which is teamwork between medicine and information technology, telemedicine has introduced many promising options and devices. Each and every device which is developed has in itself specially designed features to meet certain expectations and needs. Therefore, device selection should be based on target patients, needs, and expected results. During the period of our study, the major concern of our patients was "what they should do after the drug therapy was finished" and more importantly "what do they do after their quarantine duration finishes", "can they have regular contacts with family members thereafter?" Although many reports have defined the incubation and infectivity period of the disease, there is still uncertainty regarding the risk of infection these patients have for others (24, 25) . During our study we came up with interesting information about the duration of symptoms. Most of our patients still had dry coughs during the 3rd and 4th weeks of their illness, which means they were still symptomatic, and more interesting was the fact that some symptoms appeared during the follow-up period, as an example diarrhea was first detected in some of our patients during this period, and considering the fecal transmission of the disease it seems that the available protocols of quarantine and patient isolation should be revised (26, 27) . 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