Patient use of pulse oximetry to support management of COVID-19 in Greater Manchester: A non-randomised evaluation using a target trial approach.

Autor: Rubinstein F; The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom., Williams R; NIHR Applied Research Collaboration Greater Manchester, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom., Dumville J; NIHR Applied Research Collaboration Greater Manchester, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom., Kane B; Manchester University Foundation Trust, Manchester, United Kingdom., Whittaker W; NIHR Applied Research Collaboration Greater Manchester, Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom., Bower P; NIHR Applied Research Collaboration Greater Manchester, Division of Population Health, Health Services Research and Primary Care, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom., Kontopantelis E; NIHR Applied Research Collaboration Greater Manchester, Division of Informatics, Imaging and Data Science, Faculty of Biology, Medicine and Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2024 Nov 15; Vol. 19 (11), pp. e0310822. Date of Electronic Publication: 2024 Nov 15 (Print Publication: 2024).
DOI: 10.1371/journal.pone.0310822
Abstrakt: Introduction: The pandemic saw widespread use of home pulse oximeters to patients diagnosed with COVID-19 to support early detection of low oxygen saturation levels and appropriate care. Rapid implementation made conventional evaluation challenging, highlighting the need for rigorous non-randomised methods to support decision-making about future use of these technologies. We used routine data to explore the benefits of pulse oximetry in Greater Manchester, under the 'COVID-19 oximetry at home' (CO@h) programme.
Methods: We used data from the Greater Manchester Secure Data Environment and defined study parameters using a 'target trial' model to compare patients receiving pulse oximetry under the CO@h programme, with matched controls using various comparator groups. Primary outcomes were unplanned hospitalisation and all-cause mortality. This study is based on data from the Greater Manchester Care Record (GMCR), using anonymised, routinely collected data provided in a de-identified format for research. Informed written consent is needed for primary care patient data to be collected for service improvement and research, before data extraction to the GMCR. The study was approved under protocol GMCR RQ-048, on 12/05/2022. As indicated by the University of Manchester ethics decision tool, formal ethical approval was not required for this study.
Results: The adjusted odds ratios for an unplanned hospitalisation were higher among patients receiving pulse oximetry: OR 1.86 (95% CI 1.54-2.25) at 28 days, 1.5 (95% CI 1.3-1.74) at 90 days and 1.63 (95% CI 1.44-1.83) at 1 year. Overall odds of mortality were lower among patients receiving pulse oximetry: adjusted ORs of 0.5 (95% CI 0.25-0.98) at 28 days, 0.5 (95% CI 0.32-0.78) at 90 days and 0.58 (95% CI 0.44-0.76) at 1 year. The results were robust to different comparison groups.
Conclusion: Use of pulse oximetry at home under the CO@h programme, through the resulting prioritisation for appropriate care, was associated with a higher frequency of unplanned admissions and a reduction in the risk of mortality up to 1 year later. Therefore, it is likely effective for early detection of clinical deterioration and timely intervention among patients with COVID-19. Further research is needed to understand whether this is a cost-effective use of healthcare resources.
Competing Interests: RW, JD, PB, FR and EK were supported by the NIHR Applied Research Collaboration Greater Manchester (NIHR200174) and RW and JD by the NIHR Manchester Biomedical Research Centre (NIHR203308). As explained in the data availability section, there are restrictions using patient level data and we cannot freely share the data used in this paper through the journal.
(Copyright: © 2024 Rubinstein et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
Databáze: MEDLINE
Externí odkaz:
Nepřihlášeným uživatelům se plný text nezobrazuje