Home monitoring by pulse oximetry of primary care patients with COVID-19: a pilot randomised controlled trial

Background Pulse oximetry as a home or remote monitoring tool accelerated during the pandemic for patients with COVID-19, but evidence on its use is lacking. Aim To assess the feasibility of home monitoring by pulse oximetry of patients aged >= 40 years with cardiovascular comorbidity and moderateto-severe COVID-19. Design and setting A primary care-based, open, pilot randomised controlled trial, with nested process evaluation, was undertaken in the Netherlands. Method From November 2020 to June 2021, eligible patients presenting to one of 14 participating Dutch general practices were randomly allocated to regular measurement of peripheral oxygen saturation (at least three SpO2 measurements per day for 14 days) with a validated pulse oximeter or usual care. Results All 41 participants (21 intervention, 20 usual care) completed the 45-day follow-up period. Overall, the intervention group performed 97.6% of protocolised measurements; the median daily measurement per participant was 2.7 (interquartile range 1-4). Hypoxemia (SpO2 <94%) was reported in 10 participants (in 52 measurements); of those, six consulted the GP as instructed. Participants reported a high feeling of safety (0-100 visual analogue scale): 71.8 for the intervention group versus 59.8 for the control (P = 0.09). Primary care consultations were similar across groups: 50 for the intervention versus 51 for the control. Eleven visits by 10 participants were made to the emergency department (eight from the intervention group versus three from usual care), of which six participants were hospitalised (five intervention versus one usual care). No participants were admitted to the intensive care unit or died during follow-up. Conclusion Home monitoring of patients with moderate-to severe COVID-19 by pulse oximetry appeared feasible; adherence was high, patients reported a high feeling of safety, while the number of primary care consultations remained similar to usual care.