Policy responses for Estonia - HSRM


Policy responses for Estonia

3.2 Managing cases

The first point of contact is the family physician. In case of fever, coughing or breathing difficulties, people are asked to consult their family physician via phone or other digital channels or to call the family physician advisory line 1220 (calling from abroad +372 634 6630). The family physician advisory line is available 24/7. In case of emergency, individuals can also directly call the emergency line 112 to access an ambulance.

A COVID-19 call-line 1247 was launched as of 16 March to reduce the burden of calls to GP helpline and 112. The COVID-19 call-line is focused on providing information related to the state of emergency and COVID response.

Family physicians triage the patients. Mild cases are counselled virtually over the phone or other electronic channels without an appointment, and recover at home. The Health Board, together with the Society of Family Doctors, has prepared guidelines for homecare. If the condition deteriorates and the patient needs an in-person appointment, it is done only during time that is dedicated to patients suspected with infection. Only patients who have preregistered are allowed to attend the appointment and adequate infection prevention and control should be followed at all times. If the case becomes severe and there is potential need for hospitalization, the health care provider calls an ambulance for the patient. Severe cases are treated at a hospital.
(Source: https://www.terviseamet.ee/sites/default/files/Nakkushaigused/Juhendid/COVID-19/covid-19_patsiendi_kasitlus_ja_laboratoorne_testimine_24.03.20.pdf)

In early April, the Ethics Center of the University of Tartu developed “The principles of clinical ethics in the circumstances of limited health care resources in the context of COVID-19” for hospitals at the request of the North-Estonian Medical Center and University Hospital of Tartu.  These principles provide the basis for making ethically justified decisions based on patient numbers and conditions, as well as the availability of personnel, medical supplies, equipment and medicines in the hospital.

Source: https://www.regionaalhaigla.ee/sites/default/files/documents/Eetikaalased_soovitused_A4.pdf

The Estonian Health Insurance Fund (EHIF) initiated a number of analyses and audits during the week of 20 April to assess coronavirus-prompted reorganization of treatment and the availability of medical care. This includes an audit of Kuressaare Hospital, a local hospital at the epicenter of COVID-19 treatment on an island - the most affected region in Estonia. The aim is to determine if the use of funds has been targeted and whether or not treatment guidelines have been followed.

No major capacity issues were experienced in hospitals until March 2021. Although hospitals had the ability to create additional COVID-19 beds if needed, the current high numbers of patients have overburdened the North-Estonian hospitals. The main challenge is related to the ability of skilled staff.