Methods
The study, which is a retrospective cohort type, started in May 2020 under the direction of Marmara University Health Sciences Institute Medical Pharmacology Department and was carried out between May 2020 and October 2021. Patients registered at Istanbul Uskudar Zeynep Kamil Family Health Center (FHC), Sultanbeyli Jandarma Ustegmen Rahim Celik FHC, Beyoglu 6th FHC and Eyup Islambey FHC were included in the study. Of these patients, those who were diagnosed with COVID-19 between March 11, 2020 - November 30, 2020, constituted the population of the study.
Inclusion criteria were to be a patient enrolled in the above-mentioned FHCs and to have a positive COVID-19 PCR test between 11 March 2020 and 30 November 2020 or positive COVID-19 thoracic CT findings despite a negative test. The exclusion criterion from the study was the inability to access the medical information of the included patients viae-nabiz (an application that Turkish citizens and health professionals can access health data collected from health institutions via the internet and mobile devices).
The records of the patients included in the study were scanned retrospectively. Data scanning was performed via family medicine information systems and e-nabiz . The data of the patients were collected by the researcher working in the relevant FHC and participating in the study. The information obtained from the patient files were as follows: patient’s age, gender, marital status, education level, employment status, occupation, smoking habit, date of first diagnosis, first application complaint, COVID-19 PCR test result, presence of COVID-19 findings in thoracic CT, received COVID-19 pharmacological treatment, presence of comorbidity and medications used in the previous 6 months. The medications utilized in the previous 6 months were recorded according to the Anatomic Therapeutic Chemical (ATC) 5 classification. It was then further grouped according to ATC 3. These data were compared with the three main endpoints of the study, namely, the need for hospitalization, the need for intensive care unit (ICU), and mortality in comparative analyses.
SPSS 21.0 was used for statistical analysis. Frequency analysis was performed by specifying numbers and percentages for categorical variables. Normal distribution was tested using Kolmogorov–Smirnov test. Mean and standard deviation were used for continuous variables, and median and range of values ​​were used for non-parametric variables, as measures of central tendency and dispersion, respectively. Logistic regression was used to compare the independent variables with the three dependent variables. The direction of the comparisons was confirmed by correlation analysis and Pearson chi-square test. All logistic regression models were adjusted for age and comorbid conditions. Demographic data were also compared between outpatients, hospitalization, ICU admission and mortality using Pearson-chi square test, when needed Fisher’s exact test. For parameters with nonnormal distribution, ranks were compared using Kruskal–Wallis test. For normally distributed parameters, means were compared using one-way analysis of variance (ANOVA) test. In the presence of significant variables Tukey’s post hoc test was performed after ANOVA test, Dunn test was performed after Kruskal-Wallis test and Pearson chi-square or Fisher’s exact test in pairs were performed after Pearson chi-square or Fisher’s exact test.
To obtain study data from family medicine information systems ande-nabiz , permission was obtained from the Turkish Republic Ministry of Health General Directorate of Health Services Scientific Research Platform on 29.04.2020. Before starting to collect the study data, an application was made for the approval of the Marmara University Faculty of Medicine Clinical Research Ethics Committee and the ethics committee approval was obtained on 08.05.2020 with the protocol code 09.2020.552. The study was carried out in accordance with the principles in the Declaration of Helsinki.