COVID-19 pneumonia in the outpatient setting in Italy: a population-based observational study'

Background: While around 80% of symptomatic SARS-CoV-2 infections are characterised by mild to moderate respiratory symptoms, two out of ten patients develop severe disease, with pneumonia being the most common clinical outcome. Little is known about the prevalence and the patient management of SARS-CoV-2 related pneumonia in Italian general practices. Research questions: To describe the clinical features of outpatients with SARS-CoV-2 related pneumonia and the management strategies of Italian general practitioners (GPs) in the province of Modena (Italy). Method: Retrospective study of SARS-CoV-2 infected adult outpatients managed by their GPs from March to May 2020 to April 2021. Data on GPs’ monitoring and treatment strategies, patients’ clinical and sociodemographic characteristics, hospitalisation and death were extracted from the GP’s electronic medical records and were analysed using descriptive and bivariate statistics. Results: 5340 patients from 46 GP practices were included in the analyses and among these 1457 (27%) developed pneumoniae with (12%) or without (15%) respiratory failure. Among these, 940 (66 %) were managed entirely in the outpatient setting by GPs. 59% of patients received paracetamol, 33 % NSAID, 59% antibiotics, 37% corticosteroids, 47% LMWH, 14% oxygen and 3% hydroxychloroquine; significant differences were observed in prescription patterns between the first and subsequent waves. 921 (63%) patients with pneumonia received active monitoring while 611 (42%) were visited at home; this percentage remained stable despite the exponential increase in the overall number of cases and the resulting GPs’ workload. 114 (8%) patients with pneumonia died, mostly (96%) with critical disease and 27 (24%) of deaths occurred in the outpatient setting. Conclusions: The study quantifies the important contribution of Primary Care to the management of COVID-19 outpatients with pneumonia in Italy and describes the variation of therapeutic and management strategies between the first and subsequent waves.