當武漢肺炎患者「康復後」由醫院轉診至其他醫療照顧體系,目前的後勤照顧系統並無能力安全的照顧這些病患。本文作者為這個現象提出一些建議。
最重要的,所有病人轉診前皆須再次接受武漢肺炎檢測。目前仍不確定病人「臨床康復」後多久時間仍具傳染力,因此後勤照顧系統必須能照顧這些可能仍具有傳染力的病人。一個方法是在每個地區成立一間專門從事照顧武漢肺炎康復者的專責機構。一些長照醫院或醫院附設護理之家,因他們既有之感控設施及照顧複雜型病人之經驗,可能會是一個好選擇。其他一些郊區醫院,其占床率通常小於50%,也可能是一個好選擇。
基於將病患隔離於醫療設施的困難度,另一個方法是讓患者在其家中進行治療。但目前居家醫療的強度恐無法滿足照顧從醫院出院之患者,因此需加強居家醫療已在家提供醫院等級的照顧。
不管什麼方法,人員仍然是關鍵。這項工作需要高技術醫療人員並且願意在這些環境下工作。人員必須要有相關的訓練及必要之個人保護裝備以確保人員的安全。人員亦須定期做病毒檢測以確定他們沒有傳播病毒。此外,可能亦需要另外招募人員已進行技術性較低的工作。另一個則是人力不足問題,因為需求增加,他們可能會疲於奔命。遠距醫療可能是一個方法。
決策者需思考數種暫行方案以支持武漢肺炎的治療,如帶薪病假。治療這些個案意味著增加隔離、感控、及人力成本,後勤照顧系統應提供資源讓這些病患獲得高品質的照顧,Medicare應給付居家醫療以鼓勵採用這種模式。
(財團法人國家衛生研究院 莊淑鈞博士摘要整理)
National projections suggest that hospitals may be overwhelmed with patients with coronavirus disease 2019 (COVID-19) infection in the coming months. Appropriately, much attention has addressed the acute challenges in caring for this surge of critically ill patients. What has received less attention, however, is what happens as patients—most of whom will recover, even in the highest-risk groups—begin to do so. Many patients with COVID-19 will need postacute care to recuperate from their infection. However, postacute care facilities currently lack the capacity and capability to safely treat patients with COVID-19 as they transition from the hospital to other care settings or to their homes. In this Viewpoint, we present the scope of the problem and outline a series of steps that may be helpful as postacute care organizations prepare for the coming increase in patients with COVID-19.
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Author:David C Grabowski, Karen E Joynt Maddox
原文連結:https://jamanetwork.com/journals/jama/fullarticle/2763818