The coronavirus has interrupted the work of outpatient clinics: dissatisfied both doctors and patients

Located in the main hospital building, Clinicas Santara’s Outpatient Cardiology Department receives patients from all over the country on a daily basis. Several dozen people await specialized inquiries at the department reception. Some elderly patients are sitting next to each other and chatting. The receptionist accesses them periodically and asks them to keep a safe distance, instructing them to put on their protective masks correctly. As the cardiologist visit has to wait an hour or more, the waiting room quickly fills up with new patients and requests must be repeated again.

For some, safety is not a motto

The doctor from the Ambulatory Cardiology Service of Clinicas Santara (the surname Eltai is known), who did not want to appear, says that the situation in the polyclinic is very bad.

“There’s a traffic jam in the waiting room, in my head, and it doesn’t really lead to anything good. Patients of respectable age are especially conspicuous, sitting in crowds, taking off parts and masks and arguing with each other, it seems they are spitting on a pandemic. It is inhumanly difficult and dangerous to work in such conditions, ”the doctor complained.

According to her, now that the conditions for quarantine have tightened, it is clear that it is necessary to stay at home, not go to supermarkets, the abundance of people in this department in the eye of the hunger that awaits. “People are more involved here than in supermarkets, where they try to at least keep their distance,” the doctor said.

According to the doctor, the public emphasizes the availability of medical services, and this is understandable.

“But that accessibility is a stick with two ends. Obviously, for some outpatients, telephone counseling would suffice, but from my understanding, not much is provided, unlike what happened in the spring. The organization of the work of the polyclinic, to put it mildly, should be improved and security should be further increased. And now the beds with struggling patients pass through our room, I am a spectacle. But ordinary doctors can’t do anything here. I can’t even make my name public, because they will eat me like that wolf in sheep, ”said the doctor, who wanted to remain anonymous.

The loads are increasing

Head of the Family Medicine Center of Clinicas VUL Santara doc. Dr. Lina Vencevičienė agreed that the doctors working at the polyclinic did not prevent the increased workload.

“Of course, there are a growing number of mild COVID-19 patients whose condition is monitored remotely by family doctors and nurses. As the number of additional patients increases, consultation time shortens, it is not always possible to solve all problems in one consultation. In addition, the care of patients with various chronic diseases becomes a headache for doctors, when patients do not agree to go to the Family Center to be examined or investigated due to the epidemiological situation, and their condition cannot be assessed by phone, “said the doctor.

When asked what patients in polyclinics complain about during the quarantine period, L. Vencevičienė highlighted psychological problems.

“Complaints of anxiety have increased during counseling to patients, especially the elderly. Patients are concerned about the risk of COVID-19 infection, social isolation, overload of the medical system, which could reduce the availability of medical services. Anxiety causes sleep disturbances, fluctuations in blood pressure, blood sugar (in people with diabetes). Of course, chronic diseases have not disappeared anywhere, so most of the patients are consulted about their treatment and extension of compensatory medications, “said the doctor.

According to L. Vencevičienė, it is worrying that with the increase in the number of patients with COVID-19, the number of patients who turn to a family doctor for prevention programs has decreased.

“After the first quarantine, there was an increase in the health problems of the patients: more younger patients requested preventive examinations and now the situation is different. Comparing the months of November and December, the implementation of prevention programs decreased by almost a third ”, said the head of the Center for Family Medicine. True, he noted that the cervical preventive program stands out here, according to which more oncocytological smears were taken last year.

Polyclinics: a fortress with difficult access

Meanwhile, according to patient representatives, without reducing the number of COVID-19 patients, opportunities for timely care for patients with other diseases are reduced in polyclinics.

“This is due to the lack of various specialists: they are referred to work with COVID-19 patients, or they become ill themselves or are forced to isolate themselves.” Furthermore, a significant proportion of sick people avoid seeking medical care themselves for fear of contracting the virus. As a result, preventive examinations are more passive, psychological problems are not resolved, ”said Vida Augustinienė, president of the Council of Representatives of Lithuanian Patient Organizations.

According to her, unlike the first quarantine, when there were no opportunities for people with other diseases to enter medical institutions, specialized consultations and examinations were canceled, currently outpatient services are provided, there are only limited contact meetings with doctors from family.

“There are many additional restrictions due to security, doctors are burdened by bureaucratic work, fewer patients can register for contact consultations,” noted V. Augustinienė.

One of the main shortcomings of the work of the polyclinics was the long waiting period for registration with the doctors.

“Myself, although I have diabetes, asthma, I saw a family doctor for the last time in February. Due to reimbursable medications or necessary tests, you have to register in advance for a remote consultation, wait more than a week, not to mention that it takes a long time to call the front desk. Not only that, there are a number of patients who have not yet seen specialists due to postponed consultations during the first quarantine, ”said V. Augustinienė.

Your observation, many shortcomings and electronic health system.

“For example, when registering online, you only see the working hours of doctors for a few weeks, if there is no longer enough time to reach the next month, there is no such possibility. Also, if, for whatever reason, a patient cannot arrive at the recorded time, they must first cancel the current record in order to schedule an appointment at a later time, which is time consuming. For example, in a remote consultation, if the doctor does not call on the appointed day, he has to re-register the next day and wait again, “he said.

According to V. Augustinienė, for these reasons, patients have to buy the drugs at full price, and if they don’t have the funds, they hardly take the drugs. “We don’t get exams, we don’t have access to specialists without an appointment with the GP, and they don’t always give those appointments remotely,” he said.

Systemic change is missing

The Chairperson of the Council of Representatives of Lithuanian Patient Organizations noted that systemic changes were needed to provide accessible health services in a timely manner.

“First, the e-health system should be implemented, the bureaucratic work of doctors should be reduced, nurses can provide more services, so that doctors can focus on patients, not just filling out documents. In some In cases, the system could be organized in such a way that people could reach some of the necessary specialists with clear diagnoses without sending a mediator, a family doctor ”, suggested V. Augustinienė.

She is convinced that a political decision must be made and claims that the Compulsory Health Insurance Fund (PSDF) budget is not enough to pay the real prices of services so that everyone can receive free treatment. “It is necessary to look for additional sources of financing, such as the additional legalization of voluntary insurance. The contributions of the insured persons from the state budget to the PSDF budget must be compared with the contributions of the employees. It is also necessary to change the reimbursement procedure of drugs. People need to receive the best treatment for their individual doctor, not just the cheapest drug, “he said.

Preventive controls are less

Official data show that in recent months, residents of the country have visited polyclinics less and less. According to data from the State Health Insurance Fund, 1,436 million people were registered in primary outpatient health care institutions in November. visits: 7.1 percent. less than in October. Of these, 769 thousand. They were contact, 667 thousand. – remote.

Preventive health programs are also used more passively. According to data from the Vilnius Territorial Health Insurance Fund, in the cardiovascular disease prevention program for men aged 40 to 54 and women aged 50 to 64 in 2019. January June 48,2 thousand participated. people or nearly 48%. of all those who can participate in the program, while in the same period this year they decreased to 28.4 thousand. or 28 percent. all participants in the program.