Care for chronic patients during the pandemic. 5 proposals from hospitals

Nacho Vallejo

Image by Parentingupstream from Pixabay

Faced with the difficulties of a third wave of the pandemic, clinicians again need to express their concerns. And not only because of the exponential increase in the number of COVID-19 patients but also because of the feeling of once again leaving behind the care of patients with chronic health problems. It’s a situation sadly favoured by the collapse of primary care and hospitals.

In this blog we have already addressed this circumstance before: Salvador Casado has proposed some practical ideas for transitional primary care; Anna Sant has reflected on the need to redefine or create new roles, and Jordi Varela has argued the importance of generating the radical change to meet the needs of complex patients in the community. But what can we do from hospitals?

In July 2020, the Harvard Business Review published an interesting article How Hospitals Can Meet the Needs of Non-Covid Patients During the Pandemic. One of the keys to identifying this entry is the importance of focusing not only on the acute care of patients with COVID-19 but also on working proactively to continue addressing other health issues. The goal is to provide the greatest possible stability to the processes, gain in health and avoid the danger of postponing health care, which will result in an increase in hospitalizations, stays and readmissions in the future and will end up straining our system at all levels, not only in hospitals.

What are the proposals that this work provides to guide the attention of chronic health problems in times of pandemic?

1. Offer effective digital strategies for proactive and outpatient management of chronic diseases: real-time clinical records, tools for virtual care of patients synchronously and asynchronously, health education, virtual group visits and remote health care interventions that focus on lifestyle changes, even taking advantage of social media.

2. Redistribute essential clinical services between different hospitals. Instead of each hospital redundantly providing the full set of clinical services, concentrate them in one place. This strategy is fraught with challenges and requires increasing inter-agency collaboration and strengthening the role of health administration in centralizing decisions, but there are still examples of this and its benefits are beginning to be identified as in New York, Boston or Daegu (South Korea).

3. Hospitalize COVID-19 patients according to their underlying pathologies. In my interpretation, it’s another twist to the COVID multidisciplinary teams. That is, without losing the character of "teamwork and multidisciplinary", take advantage of the skills of the most general professionals to care for people with various chronic health problems and SARS-CoV-2 infection and facilitate other professionals to attend preferably to patients with health problems that are more familiar to them.

4. Have post-acute care centres according to whether they are COVID or non-COVID patients and strengthen outpatient/home follow-up strategies to speed up stays and avoid one of the problems that clinicians face and that often generates bottlenecks: the need for delay hospital discharge. This may be due to clinical problems, but also to the functional deterioration caused by hospitalization (more pronounced if possible in conditions of isolation), inadequacies of families to meet the recommendations of isolation in homes and the very absence of social resources in the outpatient setting.

5. Last but not least, primary care is a safeguard against COVID-19 and with a clear goal: to keep patients at home, away from hospitals and emergency services. As additional reading for this section, the article published in The Lancet Prevention and control of non-communicable diseases in the COVID-19 response is very interesting.

Meeting the needs of people with chronic health problems should be one more point on our daily agenda of preferences despite pressures and challenges. The reinvention of our health care system seems essential to give an effective response on all open fronts, including paying attention to chronic disease. This requires greater involvement of politicians and administrations, taking into account the opinion of chronic patients and the voice of professionals, facilitating disruptive innovation, more remote health care, cross-leadership, greater autonomy and less bureaucracy in our institutions and better use of our resources. We hope that with these and other measures we can all work together to reduce the impact and collateral damage of the pandemic.