Healthcare professionals from Hamad Medical Corporation (HMC) and Primary Health Care Corporation (PHCC) currently care for nearly 3,000 patients living in the community across Qatar, most of who are aged 60 years and older.
The home healthcare teams provide valuable care to patients who are unable to, or advised not to, visit a clinic for certain procedures. Between early March and the end of May 2020, the team has conducted over 22,300 home visits.
The Ministry of Public Health (MOPH) recommend early on in the pandemic preparedness that routine, nonessential healthcare appointments and procedures be postponed during COVID-19.
This guideline, for the purpose of practicing physical distancing to reduce the risk of infection spread, necessitated a change in the way that certain care is delivered to patients, including essential home healthcare services.
Dr. Hanadi Al Hamad, National Lead for the "Healthy Ageing" Priority within the National Health Strategy and Medical Director of Rumailah Hospital and Qatar Rehabilitation Institute, explained that where possible, in-person visits were being substituted for telecare, such as phone and video calls, but that overall patient interactions remained high.
"Our initial goal was to limit face-to-face interactions of patients with people outside their immediate household to reduce the risks of patients or staff being exposed to the virus," said Dr. Al Hamad. "But home healthcare teams provide key services that enable vulnerable individuals to remain in the safety of their own homes rather than going outside for treatment. Especially people with chronic healthcare problems, many of who are older patients, are more at risk of getting seriously ill if they get infected, and these patients usually benefit from having routine and preventative care provided in the comfort of their home."
While nearly 70% of all patient interactions are currently conducted virtually as telephone and video conferences, several healthcare procedures need to be performed onsite by a professional doctor or nurse.
The most common home healthcare procedures include phlebotomy (taking blood samples from a patients vein for testing) and regular INR checks for people using blood-thinning medication (teams take their portable machines to conduct these tests in the patients home for fast assessments).
Healthcare professionals also regularly perform wound care management and administering IV therapy such as for antibiotics, TPN nutritional feeds and Enzyme Infusion therapy.
Our nurses are trained to take swabs for COVID-19 testing if required, thereby relieving the need for frail individuals to go to an external testing site; we have performed more than 40 such tests on elderly patients in their home in the past two months," explained Nadya Al Anzi, Executive Director of Nursing for Home Health Care Services and Private Nursing at HMC highlighted the important role that home healthcare staff provide in keeping patients safe.
"Not only do homecare teams provide practical services, but they also provide important preventative functions. There is a huge value of on-site assessments to ensure vulnerable patients receive the right care, and many of our nurses will enlist a doctor in a telephone consultation or the mobile doctor service if they feel the condition warrants specialist advice.
Psychosocial support is equally important, particularly during a crisis when peoples anxiety levels are higher than usual and some patients might be suffering from loneliness due to social isolation. Our staff routinely make calls to our patient population to inquire about their wellbeing and escalate patient care concerns to the physicians on call," added Ms. Al Anzi.
Dr. Essa Al Sulaiti, Medical Director of HMCs Home Health Care Service advised that while there was a need to reduce the home visits in the short term, the policy was always to maintain a high level of patient interaction to reduce the risk of having a growing population of more acute patients to care for in the long term.
"Similar to observations from other countries, the local experience in Qatar has been that a number of people, especially among the elderly and their families, were afraid to go to the hospital or their primary health center as well as receive treatment at home due to concerns over contracting the virus. The danger with this is that some individuals may wait too long before receiving medical attention, leading to an increased risk of their health deteriorating to such an extent that they require hospitalization, which should be avoided when possible, especially during this pandemic," said Dr. Al Sulaiti.
"In order to avoid sending our older patients to the emergency facilities, we either aim to offer telephone consultations, or home care visits, or we provide specialist care in the Elderly Day Care Unit in Rumailah Hospital."
Home health care services are offered through HMC and PHCC, and teams are increasingly collaborating to optimize patient care and improve operational efficiencies. In the past few months, on average over 4000 calls and virtual consultations are conducted every month, with the highest numbers witnessed in March, especially after the first case was reported in late February and the commencement of COVID-19 restrictions.
"This pandemic is affecting the whole world, but healthcare challenges faced by individuals in our communities need to be addressed locally and we need to remember that the reason healthcare workers conduct home visits is because these individuals require help. If they do not get the routine or preventative care they need, they may end up in needing emergency care which is not ideal," said Dr. Samya Ahmad Al Abdulla, Senior Consultant Family Physician Executive Director of Operations at PHCC.
"In addition to visits, PHCC proactively contact elderly patients and chronic patients on a regular basis to ensure that they have all the information and support they may require. We are also actively testing home health care patients to further allow us to protect our communities and avoid external testing site," added Dr. Al Abdulla.
A significant investment has been made to develop and strengthen home care services across Qatar in recent years, allowing the home health care services to continue to care for their patient population in the best possible way to safeguard the vulnerable in the community. While existing patients are being contacted proactively by the respective healthcare teams, new patients will be referred following a telephone assessment of their condition.
Concerned new patients or their families can call the government COVID-19 helpline on 16000 to speak to a geriatrician or family doctor, who will decide if the situation requires a home visit by a member of the HMC or PHCC home healthcare teams.
All healthcare teams take extra safety precautions to mitigate the risks of virus transmission and keep their patients as safe as possible.
Every home healthcare team member is tested regularly to check for COVID-19; teams also self-monitor for potential symptoms every morning before commencing their shift and at the end of day. Part of the precautionary safety procedure includes staff to take their temperature and assessing their wellness and informing their supervisor immediately of any concerns.
Moreover, staff will conduct home visits dressed in appropriate personal protective equipment (PPE), for their safety and that of their patients.
Conversely, patients are also screened using appropriate protocols before visits, including checking them for fever, shortness of breath, a cough and whether they have had exposure to the virus elsewhere.
The visits are scheduled in advance and reconfirmed the day before the appointment to ensure improved operational performance as well as patient care satisfaction.
(Source: Qatat News Agency - QNA)
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