@article{fdi:010088920,
  title = {{COVID}-19 patient experiences in prehospital pathways : a processual approach using life-events calendar method and state sequence analysis shows detrimental delays},
  author = {{L}utaud, {R}. and {C}ortaredona, {S}{\'e}bastien and {D}elorme, {L}. and {P}eretti-watel, {P}. and {M}irouse, {J}. and {B}org, {M}. and {C}attaneo, {L}. and {T}hery, {D}. and {G}entile, {G}. and {P}radier, {C}. and {I}rit, {T}. and {B}rouqui, {P}. and {T}ardieu, {S}. and {C}arles, {M}. and {G}entile, {S}.},
  editor = {},
  language = {{ENG}},
  abstract = {{O}bjectives {T}o our best knowledge, no study in {F}rance has comprehensively investigated the prehospital history of patients admitted for severe cases of {COVID}-19. '{P}atients' voice is an excellent means to capture data on primary care pathways.{W}e aimed to identify clusters of {COVID}-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes.{O}bjectives{T}o our best knowledge, no study in {F}rance has comprehensively investigated the prehospital history of patients admitted for severe cases of {COVID}-19. '{P}atients' voice is an excellent means to capture data on primary care pathways.{W}e aimed to identify clusters of {COVID}-19 hospitalised patients with similar prehospital symptom sequences, and to test whether these clusters were associated with a higher risk of poor clinical outcomes.{D}esign{C}ross-sectional online survey using life-event calendars.{S}etting{A}ll patients hospitalised for {COVID}-19 between {S}eptember 2020 and {M}ay 2021 in the {I}nfectious {D}isease {D}epartments in {N}ice and in {M}arseilles in {F}rance.{P}articipants312 patients responded to the survey.{M}ain outcome measures{F}rom the day of symptom onset to the day of hospitalisation, we defined a symptom sequence as the time-ordered vector of the successive symptom grades (grade 1, grade 2, grade 3). {S}tate sequence analysis with optimal matching was used to identify clusters of patients with similar symptom sequences. {M}ultivariate logistic regressions were performed to test whether these clusters were associated with admission to intensive care unit ({ICU}) and {COVID}-19 sequelae after hospitalisation.{R}esults{T}hree clusters of symptom sequences were identified among 312 complete prehospital pathways. {A} specific group of patients (29%) experienced extended symptoms of severe {COVID}-19, persisting for an average duration of 7.5 days before hospitalisation. {T}his group had a significantly higher probability of being admitted to {ICU} (adjusted {OR} 2.01). {T}hey were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. {S}imilarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.{T}heir relatives played a decisive role in their hospitalisation.{R}esults{T}hree clusters of symptom sequences were identified among 312 complete prehospital pathways. {A} specific group of patients (29%) experienced extended symptoms of severe {COVID}-19, persisting for an average duration of 7.5 days before hospitalisation. {T}his group had a significantly higher probability of being admitted to {ICU} (adjusted {OR} 2.01). {T}hey were less likely to know a loved one who was a healthcare worker, and more likely to have a lower level of education. {S}imilarly, this group of patients, who were more likely to have previously visited the emergency room without exhibiting severe symptoms at that time, may have been inclined to postpone reassessment when their health worsened.{T}heir relatives played a decisive role in their hospitalisation.{C}onclusion and relevance{T}his study highlights the negative impact of delayed hospitalisation on the health outcomes of {F}rench patients with severe {COVID}-19 symptoms during the first wave and underscores the influence of socioeconomic factors, such as lower education levels and limited connections to the medical field, on patients' experiences.},
  keywords = {{COVID}-19 ; {P}atient {N}avigation ; {P}rimary {H}ealth {C}are},
  booktitle = {},
  journal = {{F}amily {M}edicine and {C}ommunity {H}ealth},
  volume = {12},
  numero = {1},
  pages = {e002447 [12 p.]},
  ISSN = {2305-6983},
  year = {2024},
  DOI = {10.1136/fmch-2023-002447},
  URL = {https://www.documentation.ird.fr/hor/fdi:010088920},
}