• Main capacity challenges within
At the height of the epidemic, challenges arose at various levels.
There was a problem with the availability of resources for work.
In some hospitals there were problems with a lack of respirators as well as a lack of bed capacity. In these situations, hospitals arranged for patients to be relocated to nearby health facilities. Respirators were redistributed where they were most needed.
There was also a problem with the lack of human resources. In the absence of medical staff in some institutions, mobilization was carried out. There was not enough time to educate the staff properly to work in the intensive care units (i.e. handling the respirators).
The COVID-19 crisis has significantly affected the mental health of health professionals themselves. This type of stress was called "moral injury". Healthcare workers had to single out patients who would receive treatment due to overcrowding of the health care system and hospital capacity.
Measures to keep Covid patients from overwhelming hospitals
Health and social institutions in several counties have reached an agreement on the management of COVID-19 patients. For example, the earthquake that occurred in Sisak-Moslavina County significantly reduced the number of hospital beds for the provision of care. As the number of COVID-19 patients in the local nursing home increased sharply, the Sisak General Hospital, in cooperation with the nursing home, agreed that all COVID-19 patients remain in the care of the nursing home in its inpatient unit. Sisak General Hospital provided the nursing home with the consultant infectologist in order to coordinate the care for COVID-19 patients.
The changing role of primary care and GPs in managing cases during the autumn and winter 2020/21
Given the protracted nature of the pandemic and the different level of resources available for service providers, the roles of public health, PHC/service delivery and hospitals may have changed over the months. The number of positive cases in Croatia in autumn and winter was very similar. After the summer of 2020, the number of COVID-19 patients began to rise sharply. The number of infected started to fall at the end of January 2021, which is actually the result of a lockdown introduced at the end of December 2020.
Significant changes occurred in primary health care during the COVID-19 pandemic are:
• Primarily, only emergency examinations were performed, but gradually general practitioners received all acute and chronic patients who needed some form of care.
• Due to the systematic transition to e-referrals, the number of patients visits to general practitioners has significantly decreased
• During the COVID-19 pandemic there was an increase in email and phone consultations
• A greater number of working hours of general practitioners was recorded due to the increase in administrative work related to patients with COVID-19 and their contacts
• Increase in everyday use of PPE
Changes in the health status of citizens:
• An increase in number of consultations due to fever
• An increase in consultations due to existential worries manifesting as depression and anxiety in working-age people
• An increase in consultations due to depression and anxiety in elderly patients probably due to a number of different factors associated with the pandemic
Family physicians are the first point of contact. However, people who do not have a family physician in Croatia, e.g. Croatian citizens who live and work in other countries, can contact an epidemiologist who will refer them for testing. There are a number of telephone lines dedicated to COVID-19.
There is no specifically defined triage for COVID-19 patients. If the patient does not feel well, they should call the family physician who will give further instructions depending on the patient's clinical condition.
There is a specific protocol in hospitals. Tents were set up at the main entrance of each hospital. Medical staff takes patient's identification data, checks their epidemiological status and measures the body temperature. If a patient with potential infection of COVID-19 arrives, they will be immediately referred to a specific point for further treatment, in accordance with the protocol for suspected COVID-19 cases.
At present, no unlicensed treatments are being tested.
No information is available on rationing care for COVID-19 patients.