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Brief ReportBrief Report

Telephonic Follow-up and the Risk of Death in Ambulatory Patients with COVID-19

Héctor Raúl Vargas-Sánchez, Juan Carlos Tomás-López, Verónica Álvarez-Medina, Luisa Estela Gil-Velázquez, Hortensia Vega-Vega, Alejandro Alarcón-López, Rafael Pérez-Villegas, Claudia María Carbajal-García, Eugenia del Rocío Rivera-Tello, Manuel Cervantes-Ocampo, Célida Duque-Molina and Iván de Jesús Ascencio-Montiel
The Journal of the American Board of Family Medicine February 2023, 36 (1) 164-169; DOI: https://doi.org/10.3122/jabfm.2022.220214R1
Héctor Raúl Vargas-Sánchez
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS
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Juan Carlos Tomás-López
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Verónica Álvarez-Medina
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA
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Luisa Estela Gil-Velázquez
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Hortensia Vega-Vega
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA, PhD
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Alejandro Alarcón-López
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MPH
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Rafael Pérez-Villegas
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA
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Claudia María Carbajal-García
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA
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Eugenia del Rocío Rivera-Tello
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA, MPH
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Manuel Cervantes-Ocampo
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS
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Célida Duque-Molina
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA, PhD
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Iván de Jesús Ascencio-Montiel
From División de Medicina Familiar, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Hospital de Ginecoobstetricia con Medicina Familiar 60, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Coordinación de Atención Integral a la Salud en el Primer Nivel de Atención, Instituto Mexicano del Seguro Social, Mexico City, Mexico; Dirección de Prestaciones Médicas, Instituto Mexicano del Seguro Social, Mexico City, Mexico; and Coordinación de Vigilancia Epidemiológica, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
MD, MS, MA
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    Figure 1.

    Weekly distribution of the number of COVID-19 cases, in the comparison groups.

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    Table 1.

    Patients’ Characteristics According to the Study Group

    CharacteristicsWith Telephonic Follow-upWithout Telephonic Follow-upBoth GroupsProportion Difference (95% Confidence Interval)
    Number of subjects535,898962,9101498,808
    Sex
    Female276,658 (51.63%)513,541 (53.33%)790,199 (52.72%)
    Male259,240 (48.37%)449,369 (46.67%)708,609 (47.28%)1.71 (1.54, 1.87)
    Age group
    20 to 39 years old307,878 (57.45%)576,422 (59.86%)884,300 (59%)−2.41 (−2.58, −2.25)
    40 to 59 years old193,696 (36.14%)311,931 (32.39%)505,627 (33.74%)3.75 (3.59, 3.91)
    60 or more years old34,324 (6.40%)74,557 (7.74%)108,881 (7.26%)−1.34 (−1.42, −1.25)
    Occupation
    Employee334,484 (62.42%)603,120 (62.64%)937,604 (62.56%)−0.22 (−0.38, −0.06)
    Housewife37,804 (7.05%)65,434 (6.80%)103,238 (6.89%)0.26 (0.17, 0.34)
    Other163,610 (30.53%)294,356 (30.57%)457,966 (30.56%)−0.04 (−0.19, 0.11)
    Epidemic wave
    2nd wave143,578 (26.79%)165,293 (17.17%)308,871 (20.61%)9.63 (9.49, 9.77)
    3rd wave229,929 (42.91%)253,596 (26.34%)483,525 (32.26%)16.57 (16.41, 16.73)
    4th wave162,391 (30.3%)544,021 (56.5%)706,412 (47.13%)−26.2 (−26.5, −26.04)
    Geographical region
    South101,093 (18.86%)136,131 (14.14%)237,224 (15.83%)4.73 (4.60, 4.85)
    Center303,098 (56.56%)600,880 (62.4%)903,978 (60.31%)−5.84 (−6.01, −5.68)
    North131,707 (24.58%)225,899 (23.46%)357,606 (23.86%)1.12 (0.97, 1.26)
    Comorbid conditions
    Obesity52,662 (9.83%)76,340 (7.93%)129,002 (8.61%)1.90 (1.80, 2.00)
    Hypertension52,532 (9.80%)89,473 (9.29%)142,005 (9.47%)0.51 (0.41, 0.61)
    Diabetes34,464 (6.43%)60,259 (6.26%)94,723 (6.32%)0.17 (0.09, 0.25)
    Tobacco consumption27,233 (5.08%)45,633 (4.74%)72,866 (4.86%)0.34 (0.27, 0.42)
    Asthma8,262 (1.54%)14,415 (1.5%)22,677 (1.51%)0.04 (0.00, 0.09)
    COPD1,697 (0.32%)43,16 (0.45%)6,013 (0.40%)−0.13 (−0.15, −0.11)
    Cardiovascular disease2,274 (0.42%)54,72 (0.57%)7,746 (0.52%)−0.14 (−0.17, −0.12)
    Immunosuppression1,510 (0.28%)28,77 (0.30%)4,387 (0.29%)−0.02 (−0.03, 0.00)
    HIV infection1,797 (0.34%)23,86 (0.25%)4,183 (0.28%)0.09 (0.07, 0.11)
    Chronic kidney disease2,026 (0.38%)61,35 (0.64%)8,161 (0.54%)−0.26 (−0.28, −0.24)
    Any medical condition132,496 (24.72%)214,076 (22.23%)346,572 (23.12%)2.49 (2.35, 2.63)
    Medical outcomes
    Emergency room attention24,008 (4.48%)61,328 (6.37%)853,36 (5.69%)−1.89 (−1.96, −1.82)
    Hospitalization22,255 (4.15%)62,018 (6.44%)84,273 (5.62%)−2.29 (−2.36, −2.22)
    Endotracheal intubation1,896 (0.35%)6,301 (0.65%)8,197 (0.55%)−0.30 (−0.32, −0.28)
    All-cause death6,903 (1.29%)28,368 (2.95%)35,271 (2.35%)−1.66 (−1.70, −1.61)
    Hospitalization or death23,351 (4.36%)63,756 (6.62%)87,107 (5.81%)−2.26 (−2.34, −2.19)
    • Abbreviations: COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus.

    • Data are presented as number (%).

    • Proportion difference between groups with and without telephonic follow-up.

    • View popup
    Table 2.

    Association between All-Cause Death and the Patient’s Characteristics

    CharacteristicsBivariate AnalysisMultivariate Analysis*
    Relative Risk (95% Confidence Interval)Adjusted Relative Risk (95% Confidence Interval)
    Male Sex1.70 (1.66-1.73)1.96 (1.88-2.04)
    Age group
    20 to 39 years oldRef.Ref.
    40 to 59 years old7.27 (6.97-7.59)3.31 (3.15-3.49)
    60 or more years old70.84 (68.02 to 73.77)10.60 (10.04-11.19)
    Occupation
    EmployeeRef.Ref.
    Housewife9.91 (9.62-10.21)1.76 (1.67-1.86)
    Other4.64 (4.52-4.76)1.30 (1.25-1.35)
    Epidemic wave
    2nd waveRef.Ref.
    3rd wave0.34 (0.33-0.35)1.06 (1.03-1.10)
    4th wave0.08 (0.07-0.08)0.39 (0.37-0.41)
    Geographical region
    SouthRef.Ref.
    Center1.40 (1.36-1.45)1.13 (1.07-1.18)
    North1.91 (1.84-1.98)1.29 (1.22-1.37)
    Previous medical conditions
    Obesity2.46 (2.39-2.52)1.11 (1.06-1.16)
    Hypertension8.55 (8.38-8.72)1.12 (1.07-1.17)
    Diabetes8.68 (8.50-8.86)1.16 (1.11-1.21)
    Tobacco consumption1.41 (1.35-1.47)0.81 (0.75-0.86)
    Asthma1.12 (1.03-1.21)0.82 (0.73-0.93)
    COPD11.75 (11.25-12.27)1.21 (1.10-1.32)
    Cardiovascular disease9.34 (8.93-9.76)1.02 (0.93-1.11)
    Immunosuppression5.95 (5.52-6.41)1.54 (1.34-1.77)
    HIV infection1.24 (1.04-1.48)1.42 (1.10-1.85)
    Chronic kidney disease16.94 (16.43-17.46)2.66 (2.47-2.86)
    Any medical condition6.90 (6.75-7.05)1.31 (1.24-1.38)
    Medical outcomes
    Emergency room attention90.83 (88.32 to 93.41)2.14 (2.03-2.25)
    Hospitalization192.12 (185.00 to 199.51)38.46 (36.18-40.87)
    Endotracheal intubation46.95 (46.30 to 47.62)15.65 (14.50-16.89)
    Telephonic follow-up0.44 (0.43-0.45)0.61 (0.59-0.64)
    • Abbreviations: COPD, chronic obstructive pulmonary disease; HIV, human immunodeficiency virus.

    • *Results of a multivariate logistic regression model.

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The Journal of the American Board of Family     Medicine: 36 (1)
The Journal of the American Board of Family Medicine
Vol. 36, Issue 1
January/February 2023
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Telephonic Follow-up and the Risk of Death in Ambulatory Patients with COVID-19
Héctor Raúl Vargas-Sánchez, Juan Carlos Tomás-López, Verónica Álvarez-Medina, Luisa Estela Gil-Velázquez, Hortensia Vega-Vega, Alejandro Alarcón-López, Rafael Pérez-Villegas, Claudia María Carbajal-García, Eugenia del Rocío Rivera-Tello, Manuel Cervantes-Ocampo, Célida Duque-Molina, Iván de Jesús Ascencio-Montiel
The Journal of the American Board of Family Medicine Feb 2023, 36 (1) 164-169; DOI: 10.3122/jabfm.2022.220214R1

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Telephonic Follow-up and the Risk of Death in Ambulatory Patients with COVID-19
Héctor Raúl Vargas-Sánchez, Juan Carlos Tomás-López, Verónica Álvarez-Medina, Luisa Estela Gil-Velázquez, Hortensia Vega-Vega, Alejandro Alarcón-López, Rafael Pérez-Villegas, Claudia María Carbajal-García, Eugenia del Rocío Rivera-Tello, Manuel Cervantes-Ocampo, Célida Duque-Molina, Iván de Jesús Ascencio-Montiel
The Journal of the American Board of Family Medicine Feb 2023, 36 (1) 164-169; DOI: 10.3122/jabfm.2022.220214R1
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