More Is Needed to Support Primary Care Frontlines – Winnie Ong

It is not only during a crisis that we should reflect on how much healthcare workers and the impact they have on population health outcomes, are supported by the way healthcare is organized, financed and delivered.

In light of the current pandemic, it is prudent to highlight the roles of allied health and supporting staff, who we may not see in blue and white Hazmat suits in the news, but are working shoulder to shoulder with doctors and nurses to maintain primary care services.

From the administrator and clerk, to the medical assistant and paramedic, the lab technician, pharmacist and pharmacy assistant, ambulance driver, dietician, physiotherapist, all the way to the janitor and cleaner, these are people who are at risk of overwork and burnout, more exposed to getting sick, and face the occupational stress from dealing with illness and death on a daily basis.

Let us not forget that ongoing health care needs, like diabetes, asthma or mental health, do not halt temporarily for Covid-19. While appointed hospitals and triage teams in clinics are focusing on the pandemic response, health care workers have had to be agile and dynamic to adjust usual care services to ensure patients are not adversely affected.

People with chronic illnesses are at risk of complications both from Covid-19 and pre-existing conditions. They also need to continue current medications or replenish as-needed medications like inhalers.

For stable patients, some clinics have extended appointment dates, while others do a quick review of clinical status and vital signs before renewing medication supply.

An increase in the volume of home delivery of medications, pick up by WhatsApp, drive-thru, park and take, among others, all require the manpower and teamwork for diligent preparation and counterchecking to ensure patients get the right medications. 

Where stock levels allow, pharmacies are trying to supply a longer duration, so that patients do not have to come as often.

All of this requires administrators and assistants to contact patients, coordination of staff to ensure patients are triaged and protocols are adhered to, setup of new dispensing areas and careful inventory management of fast-moving medicines.

In order to minimise the disruption of a pandemic to usual care services, health workers are making the best of the resources available.  

Clearly there are limitations, especially in hardest-hit districts, as the situation becomes more prolonged. How can our health care workers be better equipped for patient care by further innovating the current system?

Making it easier for patients to get medicines, or having telemedicine and teleconsultation services in the private sector, proved to be literally life-saving.

Even when these were not designed with the pandemic in mind, it has shown us the potentially massive returns to investments in infrastructure and technology.

Before and during the fasting month of Ramadhan begins end of April, diabetic patients will need closer monitoring of glucose levels. The change in meal timing and quantity will require adjustments in dosing and timing of medication administration. Previously, this depended on the physical accessibility of patients to public health centres.

With wider use of telehealth, people with NCDs who need monitoring and adjustments in their medications in between their appointments could choose nearer facilities such as the GP clinic, which shares information with the original facility.

Alternatively, those with home monitoring devices could receive personalised management at a distance. Community pharmacists could become specialised and certified in NCD management in the community.

This could simultaneously increase convenience to health care users, improve care, and reduce crowding at public health centres.

One of the legacies of this pandemic should be that we continue to innovate, realising the benefits of being able to deliver functions of health care remotely or with more efficiency than previously.

Another aspect is the availability of real-time data for health care workers. While this is obviously fundamental to public health responses in infectious diseases, the ability of primary care to keep track of the health of their respective populations and design interventions for the community depend on databases and health informatics.  

In the post Covid-19 era, the value of a health workforce that is able to respond in a resilient manner to population health challenges is more apparent than ever.

We need to protect their safety, such as ensuring adequate supply of personal protective equipment (PPE) and providing mental health support. Unlike hospitals, clinics do not usually have counsellors.

Staff who has been screened using the DASS questionnaire and found to have high levels of distress should be promptly offered counselling and psychological first aid.

In the long-term, the burden on primary care will grow. The quality and specialisation of a health workforce for the future starts from policies made now.

If the health system is to be more innovative and integrated into the community, both system and human factors must be ready.

It is not only during a crisis that we should reflect on how much health care workers and the impact they have on population health outcomes, are supported by the way health care is organised, financed and delivered.

Maintaining the normal, going forward, requires us to continuously improve health services delivery.

Winnie Ong is a registered pharmacist and Research Officer with the Galen Centre for Health and Social Policy, based in Kuala Lumpur, Malaysia.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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