3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
In many hospitals, especially in the areas where the outbreak is most severe, all non-urgent medical procedures have been postponed. All face-to-face consultations, if possible, are reverted into telephone consultations. Open capacity due to postponements is used to support COVID-19 patients. Currently there are no hospitals exclusively treating COVID-19 patients.
The extent to which the postponements will affect various patient groups is not yet known. For instance, chemotherapy can be postponed, because this treatment weakens the immune system and if the patient contracts COVID-19, they may be more vulnerable. Some people hesitate to contact emergency services for other emergencies, such as pain in the chest, because they think the emergency department is too busy with COVID-19 and/or they fear contracting COVID-19 in the hospital. (https://www.volkskrant.nl/nieuws-achtergrond/afgezegde-zorg-dreigt-meer-levens-te-kosten-dan-corona~b64d16ef/; https://www.nrc.nl/nieuws/2020/03/23/de-patienten-liggen-in-een-tent-voor-het-ziekenhuis-a3994613; https://nos.nl/artikel/2328656-spoed-is-spoed-denk-niet-ze-zijn-vast-te-druk.html)
Since the pressure on care facilities is diminishing due to the lower number of admitted COVID-19 cases, regular non-urgent care will gradually resume (see Section 3.3 – Maintaining essential services).
The first point of contact for suspected COVID-19 patients is the GP or the GP out-of-hours service (unless the situation is an emergency, in that case 112 will be contacted). GPs ask patients to only visit in-person if they have an appointment, and if a patient has COVID-19 symptoms they should not go the facility but to contact the GP by phone. The GP will then decide whether the patient should go the hospital. GPs are advised to organize separate office hours for patients with respiratory complaints, abolish walk-in office hours, and use video instead of face-to-face consultations whenever possible. The waiting room should be reorganized to facilitate the 1.5 meter distance rule. Hygiene advices are provided to GPs. (https://www.nhg.org/coronavirus/organisatie-van-de-zorg)