COVID-19’s lessons learned from Primary Care and General Practice: enduring rafts against Pandemic Waves

Background: The Pandemic heavily hit northern Italy. Since most infections have mild to moderate symptoms thus Primary Care(PC) had to quickly adapt and reorganize to contribute to reducing hospital overload end ensure continuity of care. Italian literature on COVID-19 outpatient management is scarce, and little is known about overall management strategies. The study aims to describe the overall reorganization in pharmacological and monitoring strategies adopted by Italian general practitioners(GPs) to care for SARS-CoV-2 infected outpatients during the pandemic’s first waves and to evaluate their effectiveness in COVID-19 hospitalisation. Methods: This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena(Italy). Using electronic medical records, we extracted data on pharmacological and management strategies (home visits and remote monitoring), patient characteristics, and hospitalizations. We stratified data for disease severity and multiple logistic regression analysis was performed to assess the probability of hospitalization. Results: Of 5340 patients, 56%(83% with pneumonia) were actively monitored by 46 GPs and specifically created continuity-of-care-units. A significant reduction in paracetamol, antibiotics and hydroxychloroquine prescriptions was observed over time in concordance with newly released guidelines. FANS for moderate patients(OR=0.50 95%CI:0.25-0.99), and steroids(OR=0.52 95%CI:0.32-0.84), antibiotics(OR=0.42 95%CI:0.25-0.70) and heparin(OR=0.63 95%CI:0.38-1.04) for severe-critical patients were effective in reducing the probability of hospitalisation, yet none as much as GPs’ active monitoring(OR up to 0.32 95%CI:0.14-0.70) or home visits(OR up to 0.42 95%CI:0.20-0.88). Conclusion: Italian Primary Care showed to be resilient and prone to adapt management and pharmacological strategies effective in reducing hospitalization overload. Considering a new potential pandemic and given that the ending of the current one is still proceeding at a slow pace, strengthening and investing in territorial health systems is a key strategy for controlling hospital overload and its consequences on patients health.