Unprecedented situations require innovative solutions. And it is their innovative ideas and a new approach to health emergencies that helped health authorities in Pakkred District in Nonthaburi Province of Thailand ensure uninterrupted treatment of noncommunicable diseases (NCDs) including management of hypertension and diabetes amidst the COVID-19 global pandemic.
At a time when essential health services across the world were disrupted due to the COVID-19 outbreak, health authorities of the Pakkred Hospital in the Nonthaburi Province of Thailand
prioritized protecting the vulnerable population, while maintaining essential health services for patients with chronic conditions. They introduced new medical services and adapted several prevailed practices to the current situation.
Excellent leadership from Pakkred hospital director and deputy director and quick decision making helped to create continuous improvement of service quality and efficiency by using patient-centered approach.
“COVID-19 was challenging. It forced us to quickly adapt and create new systems to make services more patient-centered. Some of these good practices can be continued in future”, says Dr Soraphan Songsermpong, Chief Medical Officer, Pakkred Hospital.
Key focus areas for innovation and improvement were: Use of technology for care and communication; a fast track system for handling patients visiting hospitals; infection prevention and control measures at hospital facilities to protect NCD patients and new ways to dispense medicines.
Technology Used for Care and Communication
Health authorities in the Pakkred District used technology to establish communication lines between hospitals, health centres and health workers for better coordination and to reach out to the larger community.
The LINE application was used for online consultation between doctors, nurses and Community Health Volunteers (CHVs) in all health facilities, including affiliated health clinics and home healthcare teams.
New official LINE accounts were created for hospital staff at NCD and other clinics to communicate with patients for online consultation, update prescriptions and arrange for medicine pick up. Social media was actively used to collect inquiries from the public and submitted to concerned clinics for further actions.
A digital application called “PK COVID” was developed by Nonthaburi Health Office and SCG Group (a private-sector firm) for providing teleconsultation to patients in the district.
Safety During Hospital Visits
A fast-track one-stop service was set up for vulnerable groups such as elderly and patients with NCDs who need to visit hospitals for submitting blood samples and check-ups. The entire process from screening, to measurements to consultation with doctor until receiving medicines was organized at one place so that there was limited patient movement within the hospital. The time spent by the patient at the hospital was reduced from 2-3 hours to under one hour. Currently, the system is being implemented at NCD clinics.
An improved appointment system, with staggered appointments, ensured there were fewer patients at the facility at any given time.
For safety of NCD and other non-COVID patients, WHO-recommended COVID-19 safety protocol were put in place at all health facilities. These included enhanced ventilation, additional patient waiting areas, change in seating arrangement to ensure physical distancing and plastic screens between health workers and patients.
Dispensing Medicines
Doctors and health workers started using new methods for consultation and dispensing medicines to serious NCD patients with limited mobility. After reviewing their electronic health records, NCD case managers would contact Health Promoting Hospital staff and CHVs and arrange for check-ups for hypertension and diabetes at home before prescribing medicines. The CHVs also dispensed medicines after the check-up.
Drive thru service for patient to pick up their refill medication © Pakkred Hospital – 2020
The hospital leadership decided to adopt a policy to allow healthy and younger relatives to pick up medicines on behalf of patients after online consultations. A drive-through facility was set up at the Pakkred hospital for patients to pick up medicines from a pharmacy kiosk or a window and routine medicines were also delivered by post and through taxi services.
Whann Yensabai, a 76-year-old Pakkred resident who is suffering from hypertension, diabetes and nephrosis, is just one of the nearly 10,000 diabetes and hypertension patients who received uninterrupted health services during the pandemic. When she needed to have her BP checked and refill medicines, a CHV visited her and helped to relay her health information to staff at Pakkred hospital and also deliver medicines to her at home. “It was convenient that CHV could take care of me during COVID-19, avoiding the need travel to hospital,” she says. But apart from the convenience, the service also helped her save nearly 150 Baht in travelling cost for each visit.
For the CHVs, it is a labour of love. “I am proud to be a CHV as this work benefits my community. I am now inviting younger community members to be a CHV”, says 58-year-old
Suree Bualard, a CHV of Bang Phut sub-district. She has been working as CHV for 21 years and is responsible for 15 households. Trained in several patient care areas such as elderly care, nutrition and physical therapy, she knows almost everyone in her community and works closely with health promoting hospital staff and family health team of Pakkred hospital.
Some of the measures taken to prevent COVID-19 spread such as contract tracing and teleconsultations have helped increase the overall efficiency at the health centres in the district.
“During the COVID-19 epidemic, patients and service providers have become more aware of the importance of communication. This has helped us to have more updated contact information of patients and to follow up with them. We want to continue these good practices even after the pandemic, including multiple channels of communications with patients, updated patient contact details and teleconsultation,” says Supattra Chanthorn, an NCD Case Manager and nurse, who oversees hypertension and diabetes clinics at Pakkred Hospital.
Several health interventions made during the peak phase of COVID-19 are still being maintained in the district. Teleconsultation and “One-stop Service” for NCD patients continues shortening the overall time spent at hospitals.
Dr Renu Garg, Dr Thanaphan Suksaard and Dr Sushera Bunluesin contributed to this article.
Edited by Anita Sharma
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