Telenursing with elderly people in home care service during the COVID-19 pandemic: quasi-experimental study.

The study was not randomized; the authors say outdated home-care records made randomization impossible, so differences between groups may explain the outcomes. The groups were not identical at baseline: 94.3% of elderly people in the control group had a caregiver, compared with 85.5% in the intervention group. The authors also report a significant difference in the number of elderly comorbidities between groups. The intervention was a package of telephone assessment and many nursing guidance items, so the contribution of any single component cannot be separated. The paper reports counts by outcome, not the percentage of each group who were discharged, hospitalized or died, so absolute benefit or harm cannot be judged. Many eligible people were excluded or stopped answering: 302 were eligible, 288 were included after first-call losses, and 69 were later excluded for missing at least 25% of calls, leaving 219. Discharge decisions were made by the home-care service team during the study, not by a blinded outcome assessor. It was done in one home care service in Brazil during the early pandemic, so other services may not be comparable. The paper lists several objective outcomes but does not clearly identify one primary endpoint.

Do not read the almost nine times higher chance of discharge reported by the authors as proof that telenursing caused better outcomes. The study was non-randomized, the groups differed at baseline, and 11 of the 15 deaths were in the intervention group.