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Coronavirus threatens to sideline patients with other chronic illnesses

Health officials in Central Uusimaa are trying to ensure that non-coronavirus cases can still receive care

Sairaanhoitaja pukee suojavaatteita ylleen.
Municipalities in Central Uusimaa want to ensure that the condition of chronically ill patients does not worsen because of the pandemic. Image: Emmi Korhonen / Lehtikuva

The novel coronavirus outbreak has absorbed a great deal of the attention and resources of the Finnish healthcare system, leaving many other patients in need of treatment in the primary healthcare system high and dry.

If the situation continues for much longer Finland could be facing another crisis caused by the lack of access to care for patients with other long-term or chronic diseases. At worst, these patients face the risk of death or developing additional illnesses.

Non-essential care on the back burner

Access to non-emergency care has long been a problem in Finland. In October 2019, just 40 percent of non-emergency outpatient doctor's visits were completed within a week of referral for treatment.

The situation only deteriorated during subsequent months. As the coronavirus outbreak took hold across the country and swamped primary care facilities, fewer appointments for non-urgent care became available. This means that patients with non-emergency complaints should seek care in areas where there are few coronavirus cases.

In addition, new guidelines allow municipalities to waive patients' rights to non-essential care within the legally-mandated time limit.

However in recent weeks the Central Uusimaa social and health care municipal association (Keusote) has made a determined effort to provide care for non-emergency patients, many of whom are in coronavirus risk groups. The association serves residents of Hyvinkää, Järvenpää, Mäntsälä, Nurmijärvi, Pornainen and Tuusula.

"We hoped that residents would not cancel appointments with doctors or nurses," said Keusote interim out-patient services head Päivi Mäkelä-Bengs.

Bracing for staff infections

She added that recent weeks have been put to good use because at some point it will become necessary to more radically curtail care for chronically-ill patients as staff succumb to novel coronavirus.

"We have agreed not to wind down non-emergency care until we are in dire straits. By then we will already have a large number of employees out sick and many health centres will be completely transformed into units caring for patients with respiratory tract disorders," Mäkelä-Bengs added.

According to the municipal health care professional, once the epidemic passes, no one wants to see a Finland where the people are sicker than ever because care for the long-term sick has deteriorated. She noted that in the case of people living with diabetes for example, it is important to prevent changes in eye function or autonomous nervous system disorders.

"In a worst-case scenario, we will have risk group patients going without care for a long period and then there will be a massive need for treatment when this is all over," she commented.

Patients receiving non-emergency care have primarily been treated remotely in Central Uusimaa, with doctors and nursing contacting them by phone or text message.

The Keusote official said that does not mean that appointments are quick and light. On the contrary, she noted that phone consultations take time. She noted that there are clear benefits to this approach however as patients do not have to go out, thus increasing their risk of infection with novel coronavirus.

"If needed, the remote appointment can be changed to a live one. In general remote appointments require that the patient is [also] able to come in if necessary," she explained.

12-hour coronavirus hotline available

The regional healthcare association recently set up a coronavirus care hotline for respiratory tract infection patients to call between the hours of 8am and 8pm daily. Doctors and nurses manning the phone line have been trained to use all of the member municipalities' patient information systems.

All patients will receive remote care for as long as possible and health care professionals can monitor them at home by calling them daily to evaluate their condition.

"This gives the patient a sense of security," Mäkelä-Bengs remarked.

However if the patient’s condition requires it, they will be referred to a health centre or hospital. So far some health centres have set up isolated units to examine and monitor patients with respiratory tract disorders. However if patient numbers rise, the plan is to convert entire health centres to coronavirus facilities.

According to Mäkelä-Bengs the coronavirus hotline will also be staffed to provide psychiatric help. She added that if anything good comes out of the coronavirus crisis, it will be that cooperation among the municipalities in the roughly year-old consortium will improve.

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