Policy responses for Netherlands - HSRM

Netherlands


Policy responses for Netherlands

3.2 Managing cases

A few rehabilitation centres have set up special departments for treating post-ICU patients, to help them overcome not only the physical aftermath of the disease, but also the emotional and mental consequences. These special departments can admit patients from hospitals in a relatively early stage of recovery and thus free hospital capacity. Additionally, by starting rehabilitation treatment in an early stage, the patient may have an increased chance of full recovery. (https://www.skipr.nl/nieuws/rijndam-revalidatie-opent-post-ic-afdeling-voor-coronapatienten/; https://www.merem.nl/nieuws/merem-opent-unieke-post-covid-19-revalidatie-afdeling.htm).

In the Netherlands, a central electronic patient record is not available. There is a body that facilitates access to patient medical records in the case of emergency care, but this is only possible when patient has given explicit written consent and the treatment occurs in the region where the patient lives. As COVID-19 patients are distributed throughout the country and asking for consent is not always possible, GPs are now allowed to share patient data with Emergency Departments and GP out-of-hours facilities, even if no pre-existing consent is given. The treating physician should always ask for verbal consent when possible and if a patient had previously objected against sharing their data, this choice will be respected. This measure is valid until 1 June or as long as the COVID-19 crisis continues. It is a controversial measure according to privacy protection organisations, who are afraid that many more people in the care facilities can access the data besides the treating physician. (https://www.nrc.nl/nieuws/2020/04/15/miljoenen-medisch-dossiers-open-zonder-toestemming-a3996917)

As of the end of May, people with mental health issues as a result of the COVID-19 crisis can go the national information and referral centre for COVID-19. This centre provides reliable information on the mental consequences of COVID-19 and how to deal with it and can refer people to the appropriate care providers. The centre will be in place for two years (https://www.rivm.nl/ivccorona).

The Dutch Healthcare Institute, which advises the Minister of Health on care that should be included in basic benefits package, has advised that rehabilitation care for COVID-19 patients should be included. Rehabilitation care can be reimbursed for six months after a GP or medical specialist assesses the necessity of this care. A maximum of 50 sessions of physical therapy, 8 treatments by an occupational therapist and 7 sessions by a dietician can be reimbursed. Under normal circumstances, physical therapy is only remunerated from the 21st session onwards. The advice of the Dutch Healthcare Institute is remarkable, because normally they only advise on including care in the package that is scientifically proven to be effective, and this is not yet the case for COVID-19 rehabilitation care. The institute argued, however, that special times make special measures necessary. (https://nos.nl/artikel/2340507-herstelzorg-ernstig-zieke-covid-19-patienten-voorlopig-ruimer-vergoed.html).

In several places in the Netherlands, both during the first and the second wave, care hotels have been set up. These care hotels accommodate people who no longer need hospital care, but are not recovered enough to return to home can stay until they are fit to go home. Hospitals can discharge patients to these facilities, resulting in lower lengths of stay and thus lowering pressure on hospital capacity. The care hotels are mostly joint initiatives of the hotels (providing the building), health insurers (covering the costs) and long-term care organizations (providing personnel and logistics).

As of the end of September, a few hospitals have reinstated separate COVID-19 wards for treating infected patients.

In February 2021, the pressure on hospital capacity is still large, but there is no shortage of beds for COVID-19 patients. Regular care is, however, still downscaled. The main problem is currently the availability of sufficient staff.

The role of GPs in the Netherlands in the COVID-19 crisis in Fall and Winter 2020/21 was comparable to their role in Spring 2020. GPs take care of people who are discharged from the hospital. These patients may still require oxygen treatment that they receive at home. GPs also take care of patients that are severely ill, but who do not want to be admitted to the hospitals, since an ICU admission might lead to an unfavourable health outcome (either death or a severe and non-reversible worsening of their health condition from before the illness). GPs are the first point of contact for medical care in the Netherlands, also for COVID-19 related symptoms.

As of February 2021, GPs will play a role in the vaccination campaign for COVID-19 (see Section 3.1 for more details).

The first point of contact for suspected COVID-19 patients is the GP. Some GP practices have designated information lines for questions related to COVID-19. Otherwise, patients can call the National Institute for Public Health and the Environment or their local Public Health Service or consult www.thuisarts.nl. Furthermore, the Red Cross has a helpline available for questions concerning COVID-19. The GP decides whether a patient should be seen at the hospital. In the hospital further triage is done. Some hospitals and some GP out-of-hours services have set up a tent for rapid triage at the entrance of the hospital. Relatively mild cases are sent home again, moderate severe cases are admitted to a normal (isolation) department and severe cases are admitted to the ICU.

In principle no treatment is available for COVID-19. Some treatments may have an effect and are allowed to be administered. Since these treatments are experimental, patient consent is required before using them. This concerns treatment with chloroquine or hydroxychloroquine for patients admitted to the hospital and requiring supplemental oxygen. For more severe cases, requiring ventilation support, (additional) provision of the experimental drug remdesivir is advised by the Dutch Working Party on Antibiotic Policy (https://swab.nl/nl/covid-19).

Currently no new treatments are being tested, although Erasmus Medical Centre has found antibodies against COVID-19 and hopes to develop a treatment using these antibodies.

Before admission to an ICU and in the case a patient is still capable of communication, the physician will discuss with the patient the consequences of an ICU admission. For some patients with underlying conditions, admission may worsen their initial condition in such a way that either survival may be at risk or recovery may take extremely long and returning to a functional condition is highly unlikely. The patient and physician may then decide to refrain from ICU admission. This process for care decision-making is usual in the Netherlands. The GP will be the designated person to start this discussion before a patient is sent to the hospital and some patients may decide to stay at home. However, this may be problematic due to limited manpower capacity in homecare (see Section 2.2 – Workforce). (https://www.nhg.org/sites/default/files/content/nhg_org/uploads/20200327_fms_leidraad_triage_thuisbehandeling_verwijzen_oudere_verdenking_covid19.pdf)

In Jeroen Bosch Hospital in Den Bosch, the hospital has the philosophy that patients are better off at home than in the hospital. In the hospital, care is considered impersonal since hospital personnel are covered by protective garments and visitors are not allowed. When people stay at home, if necessary with additional oxygen supply, they stay in their own environment, which is considered to be conducive to their healing. For people who cannot stay at home, the hospital has created corona care centres, where people are cared for in a homely environment. In these centres, patients are allowed to bring one relative and care is provided by GPs and home care personnel. Two of these centres have opened already (with a total of 56 beds) and others will follow. (https://www.nrc.nl/nieuws/2020/04/01/in-dit-coronazorgcentrum-mag-je-een-mantelzorger-meenemen-a3995619)

Patients at Leiden Medical Centre are sent home early with a self-test kit that enables them to measure their temperature, blood oxygen levels and blood pressure. They report their values in a daily video call with the hospital. According to the hospital, this allows care to be provided at home when possible and in the hospital when necessary. The hospital already had experience with this type of telecare for heart surgery patients. (https://www.skipr.nl/nieuws/coronapatient-sneller-uit-ziekenhuis-door-thuismeetapparatuur/?daily=1)
Almost 100 Dutch physicians working internationally in tropical medicine have offered their services to help the hospitals of Noord Brabant, the centre of the coronavirus outbreak. Most of these physicians were working in Africa and were repatriated as a result of the coronavirus crisis. Physicians of tropical medicine are used to working in acute situations and with limited facilities. They will be added to the triage teams of the hospitals (https://www.medischcontact.nl/nieuws/laatste-nieuws/nieuwsartikel/tropenartsen-springen-bij-met-triage-in-brabant-.htm).

A few rehabilitation centres have set up special departments for treating post-ICU patients, to help them overcome not only the physical aftermath of the disease, but also the emotional and mental consequences. These special departments can admit patients from hospitals in a relatively early stage of recovery and thus free hospital capacity. Additionally, by starting rehabilitation treatment in an early stage, the patient may have an increased chance of full recovery. (https://www.skipr.nl/nieuws/rijndam-revalidatie-opent-post-ic-afdeling-voor-coronapatienten/; https://www.merem.nl/nieuws/merem-opent-unieke-post-covid-19-revalidatie-afdeling.htm).

In the Netherlands, a central electronic patient record is not available. There is a body that facilitates access to patient medical records in the case of emergency care, but this is only possible when patient has given explicit written consent and the treatment occurs in the region where the patient lives. As COVID-19 patients are distributed throughout the country and asking for consent is not always possible, GPs are now allowed to share patient data with Emergency Departments and GP out-of-hours facilities, even if no pre-existing consent is given. The treating physician should always ask for verbal consent when possible and if a patient had previously objected against sharing their data, this choice will be respected. This measure is valid until 1 June or as long as the COVID-19 crisis continues. It is a controversial measure according to privacy protection organisations, who are afraid that many more people in the care facilities can access the data besides the treating physician. (https://www.nrc.nl/nieuws/2020/04/15/miljoenen-medisch-dossiers-open-zonder-toestemming-a3996917)

As of the end of May, people with mental health issues as a result of the COVID-19 crisis can go the national information and referral centre for COVID-19. This centre provides reliable information on the mental consequences of COVID-19 and how to deal with it and can refer people to the appropriate care providers. The centre will be in place for two years (https://www.rivm.nl/ivccorona).