Background Most symptomatic SARS-CoV-2 infections produce mild to moderate symptoms. Although most patients are managed in the outpatient setting, little is known about the effect of general practitioners’ (GP) management strategies on the outcomes of COVID-19 outpatients in Italy. Objectives Describe the management of Italian GPs of SARS-CoV-2 infected adult patients and explore whether GP active care and monitoring are associated with reducing hospitalisation and death. Methods Retrospective observational study of SARS-CoV-2 infected adult outpatients managed by GPs in Modena (Italy) from March 2020 to April 2021. Information on management and monitoring strategies, patients’ socio-demographic characteristics, comorbidities, and outcomes (hospitalisation and death due to COVID-19) were retrieved through an electronic medical record review and analysed descriptively and through multiple logistic regression. Results Out of the 5340 patients from 46 GPs included in the study, 3014 (56%) received remote monitoring, and 840 (16%) had at least one home visit. More than 85% of severe or critical patients were actively monitored (73% daily) and 52% were visited at home. Changes over time in patients’ therapeutic management were observed in concordance with the guidelines’ release. Active daily remote monitoring and home visits were strongly associated with reduced hospitalisation rate (OR 0.52, 95% CI 0.33–0.80 and OR 0.50, 95% CI 0.33–0.78 respectively). Conclusion GPs effectively managed an increasing number of outpatients during the first waves of the pandemic. Active monitoring and home visits were associated with reduced hospitalisation in COVID-19 outpatients.

Background Due to SARS-CoV-2 rapid mutations, the ending of the pandemic is still proceeding at a slow pace and there is the need to strengthen and invest in health systems that avoid hospital overload and its consequences on patients’ health. Most symptomatic infections have mild to moderate respiratory symptoms and patients are managed in the context of primary care. In Italy, literature on COVID-19 outpatients management by general practitioners (GPs) is scarce. This study explores the effect of GP active care and monitoring on COVID-19-related hospitalization in patients in the province of Modena (Italy) and investigates the possible determinants of GP's management. Methods This is a retrospective cohort study of SARS-CoV-2 infected adult outpatients managed by their GPs from March 2020 to April 2021 in the province of Modena (Italy). Data on GPs’ characteristics, management strategies (visits and remote monitoring), patients’ socio-demographic characteristics, and hospitalization were extracted from the GP's electronic medical records and were analyzed using descriptive statistics and multiple logistic regression. Results 46 GPs agreed to participate, and 5340 patients were included in the analyses. 3014 (56%) patients received active daily remote monitoring and 840 (16%) were visited at home. Remote monitoring and home visits were both associated with a reduction of the probability of hospitalization rate of approximately 50% (respectively OR:0.52, 95%CI:0.33, 0.80 and OR:0.50, 95%CI;0.33, 0.78). Preliminary analysis of determinants showed that GPs’ patient load, setting, age, and sex were significantly associated with management strategies. Conclusions Active monitoring performed by GPs was effective in reducing the probability of hospitalization. Primary and hospital care integration can be effective for COVID-19 management. Studies on GPs’ characteristics and patient load and their effect on their ability to care for patients are needed. Key messages • Active remote monitoring and visits performed by Italian general practitioners effectively reduced hospitalization for COVID-19. • Primary and hospital care integration can be effective for COVID-19 management.

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Purpose of the paper:This paper analyzes Italian consumers' music habits in terms of online piracy behaviors and their interest toward subscription-based music services (SBMS), i.e. services that for a small monthly fee give users legal access to vast music libraries across multiple devices. The objective is to try and profile a piracy-prone consumer and explore if SBMS could be a viable alternative to online music piracy in Italy, where the general piracy rate is very high.Methodology: The study is based on an empirical quantitative analysis through the collection of 505 questionnaires completed by Italian consumers.Findings: The paper highlights how Italian consumers reflect the 'attitude-behavior gap' in music consumption, as they perceive online music piracy as ethically wrong, yet they still show low preference for the legal, reasonably priced choice (such as SBMS). Younger, male, lower education, students have the highest propensity towards online piracy. In addition, consumers' awareness, familiarity and interest in subscriptionbased music services are still very low. Research limitations: The limitations of the paper are linked mainly to the adapted scales, to the omission of alternative determinants of attitude towards piracy, to the composition of the sample and for analyzing only two subscription-based music services (Napster and Spotify).Managerial implications: The results call for greater efforts by music industry actors and public institutions to educate Italian consumers about the consequences of their online piracy behavior and the possible solutions offered by SBMS.Originality of the paper: This paper is the first to focus on Italian consumers' music habits, their attitude and behavior towards online piracy and their interest toward subscription-based music services as a viable alternative.