A woman is tested in a clinical temporary COVID-19 in Montreal
May 24, 2020 4: 00
COVID-19: front-line care have been neglected
A professor in the department of Work socil, University of Sherbrooke
The crisis of the COVID-19 has reminded the general public of the relevance of the public health, and especially, that the hospital remains a central institution of the system of health and social services, in the eyes of decision-makers.
This focus on the hospital at the beginning of a pandemic has delayed the preparation in other areas. This in part explains the crisis in accommodation centres, and long-term care (CHSLD) and, in a lesser extent, in home-based services, where the problems begin to emerge. Family caregivers are exhausted, the services offered to beneficiaries who have been cut off during the pandemic.
So is it also of the front-line services.
As the scientific director of the knowledge Network of services and care integrated health and first-line, and a professor and researcher at the University of Sherbrooke, I am interested in the conditions of efficiency of the organization of health and social services for the past 20 years.
The games of lights and shadows media have revealed a confusion in public opinion with regard to the first line. Microbiologists and other lung specialists have been trained in first line, so that the first line true (medical clinics, community groups, emergency services, tele-health, and ambulance services has not been the subject of much attention, except for the lines of public information (such as the Info-Social 811), the clinical screening ad hoc and emergency.
It goes without saying that the hospital specialists and emergency physicians play a most important role in such a context. There is therefore no question here of reducing the importance of the. It is also clear that the first line is not structured to accommodate a mass of people with contagious or potentially contagious. Nevertheless, the public health, the 811, screening clinics, and emergency require, for their own effectiveness, a first line that plays a crucial role.
Seven essential conditions
The first line should be able to continue to play a vital role for the clients who are most vulnerable, both in terms of physical and mental health, and social terms.
The case of Montréal-Nord, a neighborhood among the hardest hit in Canada, shows the importance of local services in the urban context where the number of vulnerable people is high. These services do exist, but have not been de facto put in priority during the crisis. It also shows the link between the first line and the long-term care.
However, a number of conditions are required for front-line services to fully play their role, including :
Provision of protection equipment and equipment samples taken before the first signs of the pandemic.
Take into consideration the chronic conditions existing prior to the Covid-19 and its psychosocial effects on patients (poor management of pain can have an effect on the ability of the person to take care of itself).
Develop and support a strategy of teleconsultation of high quality and durable, allowing patients to see their doctor or another health professional at a distance.
Plan as early as upstream of the pandemic a contribution of all community resources, including locating areas for receiving contaminated people.
Remember the importance of continuity of care for the entire population, including care in the context of pandemic (e.g. : persons hospitalized as a result of the Covid-19 will in most cases return home, and some will have to live with the consequences that will have to be x support).
Anticipate now the important echo effect which will follow over a long period, the patients including the follow-up has been postponed or altered (side effects, worsening of the health condition, loss of functional autonomy).
Ensure that the cell decision-making in times of crisis include scientific advisors experts from the first line and chronic diseases and at all levels of decision-making.
The arrival of the phase endemic
The weak performance of Quebec on access to and use of the clinical data of first line is particularly harmful in the context of pandemic, for research, for clinical decision informed and to management. It will take in the coming months to raise Quebec to the canadian level, in particular in the perspective of the phases of the replicas pandemic and, especially, of the phase likely to be endemic. The COVID-19 could become a pathology seasonal as the flu virus.
Similarly, an important research effort must be made to understand the effects of the pandemic, especially those that are not captured by official measures of public health. These are made mainly from hospital data, and on the long-term effects on health.
The first line will absorb the impact of the pandemic and the breakdown of services for months, perhaps years. Early studies, including in Scotland, suggest an excess mortality arising from common health problems masked by the COVID-19, and this for all the clients of the health system and social services.
In support of the key role of the hospital for acute care in the context of a pandemic, it is imperative to continue to develop a first line, which can ensure the continuity of its services to the most vulnerable people in times of crisis, whether in the community, at home and in medical clinics.
The first line should remain a public health priority, even in difficult times of a pandemic.
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This text first appeared on the website of the franco-canadian of The Conversation. Reproduced with permission.