Policy responses for Luxembourg - HSRM


Policy responses for Luxembourg

3.2 Managing cases

A hotline (8002 8080) was set up in the context of the COVID-19 outbreak for citizens and companies. For medical purposes the hotline should be called if the treating physician cannot be reached.  Since April 01, the hotline also offers multilingual psychological support for people who find themselves alone facing their questions and uncertainties. The hotline is available seven days a week, from 7 a.m. to 11 p.m. It is operated by qualified teams prepared to guide a person in distress, by teleconsultation in order to limit the transmission of the virus.

At the end of March, the Ministry of Health set up several channels in the primary care sector according to an organisational model aimed at protecting both the patient and the healthcare professionals. Doctors are encouraged to use teleconsultation methods (telephone, video call applications, etc.) and can issue a certificate of incapacity for work or even send a medical prescription. Any patient, whether suffering from an acute affection or a chronic disease, can be offered teleconsultation. However, the use of teleconsultation is the sole decision of the doctor who must judge the relevance of medical care from a distance rather than face-to-face. In order to provide quality care, it is necessary for the doctor performing this teleconsultation act to know the patient. The Health Directorate will provide the doctors concerned with recommendations for good practice with regard to teleconsultation in the context of the COVID-19 epidemic. For this purpose, a new act of nomenclature of physicians was introduced for teleconsultation, including for the establishment of medical prescriptions or declarations of incapacity for work.

As a result, general and specialist physicians, dentists or midwives can be reached by telephone or teleconsultation (preferably via the eConsult system). The teleconsultation can take place via audio or video. This option is to be preferred by people at risk, i.e. people over 65 years of age as well as people suffering from certain chronic diseases such as diabetes, a cardiovascular condition, a chronic illness of the respiratory tract, or who have an immune system weakened by a condition or treatment, or cancer. The general physician will, if necessary and depending on the patient's state of health, refer the patient to the most suitable structure (advanced care centres, emergency departments). Medical teleconsultations are reimbursed by the social health insurance (CNS). Until April 9, the platform had almost 600 registered doctors, more than 4,000 registered patients and almost 3,000 teleconsultations were already carried out.

Since March 30, the remote monitoring tool for COVID-19 patients, MAELA, has been operational throughout Luxembourg. This system allows remote monitoring of patients who have been tested positive for COVID-19; both those who are in isolation at home and those who have just been discharged from hospital. It aims to limit the spread of the virus and relieve congestion in healthcare structures, while offering patients follow-up by qualified professionals without exposing professionals to COVID-19.
As soon as the patient is voluntarily enrolled in this national monitoring system (carried out by the hospital at the time of discharge, or by the Health Inspection after receipt of positive laboratory results), the patient must answer a short medical questionnaire on a daily basis for two weeks. The follow-up, carried out by a team of professionals from the Health Directorate, thus makes it possible to identify a possible need for assistance or a worsening of the patient's situation. As of April 9, 388 patients have been accompanied in their convalescence at home by this new tool.

General physicians will also provide home visits for the duration of the COVID crisis, both to patients with COVID-19 symptoms and to people with non-COVID-19 related conditions. These visits will be carried out by different medical teams in order to avoid the risk of contagion.

Patients can also visit advanced care centres (Centres de soins avancés - CSA) on their own initiative for a medical examination in case of symptoms related to COVID-19. Patients do not need a prescription and can also go there for health problems unrelated to COVID-19. The four CSAs are open daily from 8 a.m. to 8 p.m. The CSAs are ambulant treatment centres that have the necessary medical equipment for initial care. However, emergencies must respect the usual channels in place in Luxembourg and not go through the CSAs. However, if a patient's state of health deteriorates while under the care of the CSA, a medical evacuation is planned.

In order to meet the essential criteria of avoiding contact between patients with symptoms of COVID-19 and other patients, these individuals are triaged as soon as they arrive at the Advanced care centre. At the reception desk, they are thus directed either to the protected COVID-19 channel or to the general medicine channel in separate waiting rooms. Their data are recorded by separate administrative departments and they are then attended by a nurse who takes their first anamnesis. Then a clinical examination is carried out by a physician. Patients who are suspected by the physician of having COVID-19 infection are tested on site. If the test is positive, they are redirected according to their state of health. Either they can go home for self-isolation or they are transferred to a hospital structure in a specially equipped ambulance if their state of health requires it.

Residents of nursing homes and residential facilities for the elderly will receive 24/7 medical presence to follow up COVID-19 and non-COVID-19 patients. Hospital emergency departments continue to operate for people with serious medical conditions or for patients with COVID-19 symptomatology with a need for hospital treatment.