How NCD patients can be managed in Thailand during COVID-19 pandemic
Every hospital tackling the influx of COVID-19 infections is at risk of becoming an epicentre. The decision to postpone appointments of patients, especially NCD and chronic illness patients with an unnecessary and non-urgent hospital visit has been made by a number of hospitals.
However, these patients still require some form of care from healthcare workers. Long suspension of a medical follow-up can result in an absence of medication which might develop severe complications. How can NCD and chronic illness patients be managed despite the protracted crisis of COVID-19?
The International Health Policy Program (IHPP) and Health Intervention and Policy Program (HITAP) has reviewed guidelines imposed in other countries and found that the potential guidelines which can be applied in Thailand include:
Policies and measures can be announced by the Ministry of Public Health (MoPH) that:
- Public health services units are required to provide a medicine delivery service and inform patients that they can receive the delivered medicines by contacting nearby hospitals.
- Every sub-district health promotion hospital is required to compile a list of NCD patients in each sub-district in order to be on track of patients’ appointments with the doctor and of their remaining medicines to ensure that they will not miss the appointment and can continue their medication due to the epidemic. There might be a notification system that notifies the patients prior to the date of medical appointment. If there are patients missing the appointment, a medical visit should be done at patients’ home to measure their blood pressure and blood glucose level and prescribe necessary medicines.
- Hospitals are required to provide a special access channel for NCD patients with a need of regular visit at the hospital in order to avoid contact with large groups of patients.
- Information technology or online applications shall be promoted to provide telemedicine, to refer patients, to deliver medicines, and to gather medical information much more easily for healthcare workers as some hospitals still rely on Line application which is not the best option for professional practices.
- Medical staff including large public hospitals and sub-district health promotion hospitals can form teams and take turns coming to work, such as a 7-day work with 7 day-offs or a plan of working every second day. These plans should be feasible since there will be a decrease in medical service that requires face-to-face meeting with patients. This way, risks of hospitals being closed down due to hospital staff being quarantined will be reduced. On the away days, the staff can work remotely instead.
Moreover, to carry out the policies and measures smoothly, certain conditions and legal limitations obstructing people from working during the outbreak should be relaxed. For example:
- Postal delivery of psychoactive drugs and additives prescribed for patients should be allowed.
- The Comptroller General’s Department should enable a direct payment for services used at sub-district health promotion hospitals, so that more patients can receive medicines at sub-district health promotion hospitals, and larger hospitals will be less crowded.
- Patients should be allowed to change the health care facility they register to through an online channel. The transferring shall be effective within 24 hours in order to provide more convenient healthcare for people.
- There should be an extension of the duration for patient referral documents (which has been already announced as a policy) and an online renewal system for the referral document without requiring patients/relatives to visit the hospital.
- Rules and regulations for telemedicine shall be specially excluded.
To consider using these policies and measures, MoPH should cooperate with other public and private sections too.