Abstract
Background. The Ministry of Health had developed guidelines for the management of COVID-19 patients in outpatient settings. Despite the development of a national guideline and its importance, no study had been conducted on compliance with the guidelines for the diagnosis and treatment of COVID-19. Therefore, the aim of this study was to evaluate the extent to which these guidelines were followed in outpatient services, specifically from the perspective of interns at Tabriz University of Medical Sciences.
Methods. This study was cross-sectional, involving all 100 interns who were completing their clinical rotations in COVID-19-related departments during February and March 2022. The data collection tool was a checklist, which was developed using the guideline for the diagnosis and treatment of COVID-19 published by the National Scientific Committee for COVID-19 Management in January 2022. The checklist comprised 29 items and was validated for both validity and reliability by relevant specialists.
Results. This study included 100 medical interns from Tabriz University of Medical Sciences. Fifty interns completed their rotations in the emergency department, and the remaining 50 in outpatient clinics. The mean compliance scores with COVID-19 guidelines, as reported by emergency department and outpatient clinic interns, were 26.54 ± 3.34 and 26.73 ± 2.16, respectively (P = 0.124). The lowest compliance rate (37%) was observed for item 22 ("Azithromycin and other antibiotics should not be used without strong suspicion of concomitant bacterial infection"). However, the majority of checklist items (89.65%) demonstrated excellent compliance.
Conclusion. Overall, interns reported good adherence to COVID-19 guidelines in both the outpatient clinic and emergency department settings. However, instances of inappropriate antibiotic and vitamin supplement prescription were observed. To mitigate unnecessary treatments, further efforts to improve staff awareness and adherence are needed.
Extended Abstract
Background
Given the constraints of hospital bed availability during the widespread COVID-19 pandemic, outpatient diagnostic and treatment modalities have become essential for all COVID-19 treatment centers. Outpatient care addresses several critical needs, including the inadequacy of hospital facilities to accommodate all patients, the prevention of additional financial burdens on patients, the reduction of hospital-acquired infections, and the enhancement of healthcare system efficiency. Outpatient management of COVID-19 patients necessitates stringent adherence to guidelines to ensure that patients receive necessary services without incurring excessive costs or time delays. Given the pivotal role of outpatient services in managing COVID-19 and the apparent neglect of these services in many medical centers, alongside the insufficient knowledge regarding guideline compliance, this study aimed to evaluate the adherence to COVID-19 diagnosis and treatment guidelines from the perspective of medical interns at Tabriz University of Medical Sciences.
Methods
This cross-sectional study involved all medical interns (n=100) at Tabriz University of Medical Sciences who were undergoing their internships in COVID-19-related departments during February and March 2021. Participants included in the study were exclusively medical interns; students from basic sciences, pre-clinical courses, and those from other departments and specialties were excluded. The study utilized a customized checklist based on the guidelines for COVID-19 diagnosis and treatment published by the national COVID-19 management committee in January 2021. After consultation with a panel of experts, including community medicine, internal medicine, and infectious disease specialists, certain items were excluded from the checklist due to the unavailability of outpatient testing for substances like chloroquine, hydroxychloroquine, zinc, vitamin D, and selenium. Conversely, an item assessing the ambulatory examination of individuals with oxygen saturation between 93% and 94% was included based on expert consensus. The checklist's validity and internal consistency were verified with a CVR of 0.83, CVI of 0.86, and Cronbach's alpha of 0.88, respectively. The final checklist comprised 29 items. Data collection involved the researcher visiting outpatient clinics at Imam Reza and Sina hospitals, where interns completed the checklist after informed consent. Compliance and non-compliance were the answer options, with one point awarded for compliance and zero for non-compliance. Data were analyzed using SPSS version 16.
Results
In this study, 100 interns from Tabriz University of Medical Sciences participated, with 50 assigned to emergency rooms and 50 to training clinics. The mean compliance score with COVID-19 guidelines was 26.54 ± 3.34 for emergency room interns and 26.73 ± 2.16 for outpatient clinic interns, with no statistically significant difference between the two groups (P = 0.124). This finding suggests that the views of emergency room and outpatient clinic interns on adherence to COVID-19 diagnosis and treatment guidelines in outpatient settings did not differ significantly (P = 0.124). The lowest levels of compliance were observed for items 22 (avoiding unnecessary antibiotics), 17 (not routinely using vitamin supplements), and 26 (not using ondansetron and metoclopramide for nausea and vomiting control), with compliance rates of 37%, 66%, and 68%, respectively. In contrast, the highest levels of compliance were found for items 19 (preferential use of famotidine for stomach acid reduction), 29 (providing patients and caregivers with sufficient information), and 10 (using acetaminophen for symptom management), with compliance rates of 98%, 99%, and 99%, respectively.
Conclusion
Overall, no significant difference was found in COVID-19 guideline compliance between interns in clinics and emergency rooms. Compliance was generally good in both groups. However, excessive use of antibiotics and vitamin supplements was common in medical centers, highlighting the need for more effective training on evidence-based treatments. Additionally, the limited time available for patient education in emergency rooms and the scarcity of nutritionists at patients' bedsides were notable concerns.