Policy responses for Norway - HSRM

Norway


Policy responses for Norway

3.2 Managing cases

MEASURES TAKEN IN 2020

The Norwegian Institute of Public Health (NIPH) has developed two decisions flow charts for managing persons (including when to test for COVID-19) with acute respiratory tract infections, one for the general public and one for healthcare employees. The guidelines were published on 8 April and last updated on 3 July.

All patients with an acute respiratory tract infection and only experiencing mild symptoms are requested to stay at home until they feel well again. Patients with more severe symptoms, such as breathing difficulties, should call their GP. If the GP is not available or the need for help becomes more urgent, they must call the emergency out-of-hours clinic (tel. number 116117).  A national helpline was established (tel. number 81555015) to reduce the burden of providing information on COVID-19 falling on healthcare workers. The helpline answers general questions about the coronavirus and is open from 08:00 until 18:00 during the week and from 10:00 until 16:00 on weekends. Additional helplines have been established by patient organisations for patients with chronic diseases.

In Oslo, where the infection rate is the highest in the country, on 23-27 March, seven so-called ‘fever clinics’ were opened. They may receive patients referred by the GPs or the emergency out-of-hours clinics.
 
Triage for COVID-19 patients (at hospitals but also at the primary care level when necessary) is to follow the criteria for priority setting, which are determined by the utility of treatment, resources and severity of condition. The resource criterion is not to be used without the assessment of utility and severity. All criteria must be assessed together for each case.

Recommendations for treatment of COVID-19 patients in hospitals are published by the NIPH, which also holds webinars and online training programmes for health personnel in all health care sectors.

So far there have not been any reports on rationing of care for COVID-19 patients.

Sources:
https://helsenorge.no/coronavirus/when-should-you-contact-a-doctor
https://www.dagsavisen.no/oslo/oslo-tilbyr-koronasjekk-pa-egne-feberklinikker-1.1687177 
https://www.helsedirektoratet.no/veiledere/koronavirus/kapasitet-i-helsetjenesten/prioritering-av-helsehjelp-i-norge-under-covid-19-pandemien/verdigrunnlag-og-prioriteringskriterier
https://www.fhi.no/nettpub/coronavirus/helsepersonell/tiltak-i-spesialisthelsetjenesten-ved-mistenkt-og-bekreftet-smitte-med-nytt/?term=&h=1
https://www.helsedirektoratet.no/statistikk/antall-innlagte-pasienter-pa-sykehus-med-pavist-covid-19
https://www.fhi.no/nettpub/coronavirus/helsepersonell/tiltak-i-spesialisthelsetjenesten-ved-mistenkt-og-bekreftet-smitte-med-nytt/?term=&h=1 
https://www.helsedirektoratet.no/veiledere/koronavirus/smittevern-for-helsepersonell/helsepersonell-bor-tilby-e-konsultasjon-eller-videokonsultasjon 

December:

From 8 December, all nursing homes have been requested to up-date the individual treatment plans/agreements for their residents, paying attention to the involvement of family/next-of–kin.

On 10 December, criteria for prioritization of ICU-patients in case of breech of ICU-capacity were published. Patients should first be triaged according to life-expectancy: patients with more than 12 months of life expectancy prior to COVID-19 are prioritized first, followed by patients with 6-12 months, and finally patients with less than 6 months of life expectancy. If it becomes necessary to prioritize among patients with more than 12 months life expectancy, utility of treatment should be given first priority, when life expectancy and utility are equal, the cost of treatment could be considered.

MEASURES TAKEN IN 2021

What are the greatest challenges in managing Covid cases at this stage in the pandemic and what is being done to address them?

A main challenge for the hospitals is the staffing of the acute care wards and intensive care units (ICU) to ensure sufficient capacity for COVID-19 patients. This results in postponing elective outpatient appointments and surgeries.

The government and local authorities are taking strict measures whenever the number of cases increases in any geographical area. The capacity of hospitals has so far not been overstretched, but there are reports on fatigue among the personnel. 

The Municipal Health Officers play an important role in managing the COVID-responses at the local level. There are variations in how well local authorities have involved them in handling and planning of the measures during the pandemic. These challenges are being recognised and various measures have been introduced to ease their workload (such as involving the GPs and introducing various incentives). GPs can provide online as well as ordinary consultations.