RubiconMD received its first COVID-19-related eConsult on January 27, 2020 from a primary care clinician concerned that a 42-year-old female with persistent fever and cough may have the virus. Since then, RubiconMD has been supporting PCPs at the forefront of the pandemic as they were trying to make sense of the rapidly changing information and guidelines by the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other leading research and clinical care organizations.
Throughout the pandemic, PCPs have been turning to RubiconMD specialists for their expertise, including infectious disease specialists, pulmonologists, and other specialists from top medical centers in the US, many of whom were overseeing Remdesivir trials at their institutions. Specialists were able to help PCPs reconcile the overwhelming amount of information from the latest experimental studies, case reports, media outlets, and various clinical guidelines, and combine this knowledge with their own clinical experience on the field. This feature highlights the learnings derived from eConsults that have supported our clinician community since January - including PPE shortages, testing protocols, decontamination guidance, medication indications, complications, and more.
At the beginning of the pandemic, most eConsults revolved around the diagnosis of COVID-19 infection due to the lack of information surrounding symptoms. Soon after, many primary care organizations began to experience capacity and inventory constraints leading PCPs to inquire about personal protective equipment (PPE) use and COVID-19 testing.
Meanwhile, various reports and studies began to create confusion around indications of medications, including Chloroquine in the prevention and treatment of COVID-19, while commonly used drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs), angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), were presented as playing a role in COVID-19 symptoms. These trends were reflected in the types of questions PCPs were submitting.
The range of possible COVID-19 symptoms gradually increased over time and PCPs started to turn to RubiconMD dermatologists, cardiologists, hematologists, etc., to get the latest expert opinions on the extrapulmonary manifestations of the virus that they started to note in their patients. As PCPs’ understanding of the presenting symptoms of COVID-19 has increased, their confusion about testing has also grown and RubiconMD specialists were able to share their knowledge on results based on specific patient presentations. Finally, specialists are progressively learning about the long-term sequelae of COVID-19 in their specialty practices and are sharing this knowledge with PCPs to empower them in the care of their patients.
We reviewed COVID-19 related eConsults submitted on the RubiconMD platform between January and August 2020 and found some insightful trends below.
Chloroquine, Hydroxychloroquine, and Azithromycin
NSAIDs, ACE inhibitors, and ARBs
Testing for COVID-19 infection
Recovery, and respiratory and neurological sequelae
As PCPs are constantly learning about the complexities of COVID-19 infection, the RubiconMD eConsult platform continues to be a tool that helps them navigate the challenges in managing patients affected by COVID-19. If you are interested in learning more about eConsults and how they can best support you, please reach out to us.