Re-organization of primary health care in Cape Town during ... · Re-organization of primary health...
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Re-organization of primary health care in Cape Town during
COVID-19 epidemicProf Bob Mash
Family Medicine and Primary Care
Stellenbosch University
Principles
• 90% of all cases of COVID-19 will be self-managed and/or managed in primary care
• Systems perspective.• Community orientated primary care• We must reduce risk to people
without COVID-19 • De-congest primary care • Emergency care continues• Opportunity for innovation and
health system strengthening
Screen and stream
• Screen all patients for COVID-19 before entry
• Integrate other screening
• Stream into “hot” and “cold” streams
• Provide immediate “see and treat” stations
In the ‘hot’ stream
• Assess and triage (mild, moderate, severe, critical)
• Manage mild and collect samples in COVID-19 testing area - home
• Admit to facility those that are moderate or worse for treatment and referral
• No intubation or ventilation in primary care
• Possibility of end of life care
• Admit to facility those needing other primary care services
In the ‘cold’ stream
• Acute non-COVID cases admitted to the emergency room or centre
• Cold stream is not COVID safe
• De-escalating of chronic care (NCDs, HIV, TB, mental health) in facility and escalating in community
• Maternity care continues
• Family planning continues, emphasis on long term options
• Immunizations and growth monitoring continues
• Most support services significantly reduced (rehabilitation, eye health, oral health, nutrition, counselling, social).
Readiness of primary care facilities
Key issues on readiness checklist
• Infrastructure – maintaining separate streams and social distancing
• People management – staff anxiety, stress and infection
• Social services – integration of health and social services
• Surge contingency plans – how to plan
• Facility level management and decision-making
• Referral pathways and availability ambulances