Given an expected increase in activity care of health services due to increased cases of influenza A H1N1 pandemic virus, authorities health must be responsive to the views of doctors are going to meet those people. With the aim of improving patient care and contribute to the efficient organization of health services, we have developed a series of recommendations on various measures to take. Some of them may make a significant modification of existing structures, but we believe that a situation might be exceptional, organizational measures must also be. These considerations do from the everyday work experience and hope for the benefit of society as a whole, are taken into account.
Proposal 1. Care for the disease
Most patients suffer mild illness that does not require specific medical attention. Call will be prioritized as the most accessible method to assess the need for clinical care of a patient. Thus, assessing the possibility that sufficient self-care measures and active monitoring by patients or their caregivers. Health authorities should disclose and recommend self-care measures to the general population as well as knowledge of the warning signs that might prompt a medical evaluation. Should be used for this purpose all available media.
Proposal 2. Assessment of the patient who comes to the health center
confident that patients affected by clinical symptoms of influenza-like illness to attend medical appointments Health Centers normally, and whenever possible, by appointment. Thus, the flow of people that need to be addressed will be ordered and fluid. If the number of cases increased remarkably in a short space of time and consultation are a lot of people without an appointment or urgent, you can organize, together with nurses and management, a classification system ( triage) to determine the need for preferential treatment or urgent by the physician. It will advise the patient with cough active measures to maintain proper hygiene while waiting to be served. Each query must have the equipment needed to maintain proper hygiene and ventilation.
Proposal 3. Home care
Home care involves about 30 minutes per patient and is not feasible, make widespread and massive, consultations and family physicians and pediatricians are at their fullest potential. Therefore, if there is an increasing demand for this type of care should implement at least some of the following measures:
- In areas where it is not undertaken directly by the 061 or other regional phone. The demand for emergency home care will be explicitly regulated in the health centers themselves, intervening in the regulation of administrative professionals and family physicians or pediatricians for under the common goal of optimizing resources and provide the best care.
- All applications will be evaluated directly home notices in telephone contact with patients or their relatives by the patient's physician, or alternatively by physicians of the health center, these professionals taking the decision to move home or not.
Proposal 4. Legal basis for temporary disability.
The time spent performing tasks under the current regulation of sick leave many patients would lead to the collapse of care for bureaucratic reasons: sick patients, low for isolation ... all with the need for a sick, confirmation, high (6 sheets printed on 3 different days). It proposes to grant an exception, an SPD off work completed by the first doctor treating the patient in any area of \u200b\u200bthe NHS (health center, SAR, hospital emergency rooms, etc..), Which will specify the diagnosis and recommended time of absence work. In this way, it would avoid duplication of visits and use a much-needed time for an administrative task. The National Institute of Social Security and Health Inspection Service and the mutual work should participate in the implementation of this model. Physicians who perform this task we know the importance of a measure of this kind to take advantage of a time and scarce. Other neighboring countries (United Kingdom) justify the absence from work for any disease of less than 7 days with a model (Absence Self Certification Form) that fills the patient.
Proposition 5. Drug treatment
Sea whatever the level of care the patient is treated (hospital, home or health center) should receive the first visit by prescription or directly if necessary, complete drug treatment to cover the period of disease development , thereby eliminating unnecessary redundant queries.
Proposition 6. In the absence of health personnel sick
The expected involvement of workers in health centers to take on difficult situations motivate the entire workload. If so, people must know that despite being an exceptional situation, there is a reasonable limit the workload of each healthcare professional. Therefore, patients are requested to submit additional pathologies preferred not to assume the need to move to second place and delaying the consultation. Health authorities have to make this public campaign and appeal to social solidarity. To ensure adequate coverage of priority health services, the administration will hire all the professionals you need, provided they have sufficient capacity. To avoid problems and achieve the necessary agility to do so, both the Administration and the unions to agree on the changes in working conditions and selection procedures for temporary staff as required.
Proposition 7. Residential homes for the elderly and other institutions.
The doctors working in the homes of elderly, disabled, etc.. public and private, including occupational physicians and work accident insurance should have sufficient autonomy to make and ratify by signing any bureaucratic exercise, including recipes, which will be determined by attendance and flu cases so far could not perform. Facing an exceptional situation and knowing the non-clinical workload generated by these issues, the priority should be the care of patients and measures should benefit and not hinder the work.
Proposition 8. The direct call to the population-enabled phones.
The use of population-enabled phones: 061, Salud Responde, Sanitat Respon, among others, and any other that enable health authorities as an information and advice, is a positive step towards the realization of a telephone triage and patient education on the proper self-care. His work can be very important if it contributes to the discharge of the direct care of patients seeking information or presenting symptoms requiring no medical assistance directly from a physician. Emergency phones (112) should be reserved for proper operation.
Proposition 9. The collaboration between the health center and hospital.
should establish an active communication between the health center and hospital for immediate treatment of high-risk patient. If the patient has been evaluated in primary care should be considered as preferred on arrival at hospital, hopes to avoid another classification (triage) hospital. To this end, the availability of electronic communication (email) would also help. Patients discharged home have to leave the hospital with their medication and to report off work completed as we indicated in Recommendation 4. This arrangement works in other countries (United Kingdom) and desirable it was usual in all types of diseases.
Proposition 10. Communication with the patient.
Patients are informed and well attended show usually sympathetic to the problems that can arise with an exceptional situation. Communication with them should be in all areas. Written information helps realize the messages. Leaflets should be made for personal delivery to all patients and their families with hygiene issues, medication, self-care tips and instructions for proper use of health services.
With good organization and information we can meet the welfare activities of the coming months with serenity, preventing the disease damage is greater than the symptoms that occur, avoiding the chaos that would cause side effects health very harmful to health population.
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participate in this initiative:
Vicente Beam *, CC Baxter *, Rafael Cofino *, ** José Cristóbal Buñuel Alvarez, Juan José Bilbao *, Julio Bonis *, Rafael Bravo Toledo *, Carlos Cebrián *, Fernando Comas ****, Juan Jose Delgado Domínguez **, Lis Ensalander * * Enrique Gavilán, Juan Gérvas *, Joseph M. Garzón *, Francisco Javier Guerrero *, Raquel Gómez Bravo *, Maria Gomez Bravo Correales * ****, Ramón González, Javier Vicente Herrero ***, ** Ales Rafael Jiménez, José Luis Quintana *, Miguel Angel Máñez ** ** ** Manuel Merino Moina, Sergio Minuet *, Miguel Molina *, ** Pepe Murcia, Rafael Olalde Quintana *, Pablo Perez ****, Jonathan Solis Ojeda *, ** David Pérez Solis, Javier Padilla +, Salva Banner *, Vicente Rodríguez Pappalardo *, Antonio Ruiz *, Iñaki Sánchez *, Mateu Seguí *, Elena Serrano + Sophie + +, Antonio Villafaina ***.
* Family doctor / GP, ** Pediatrics, *** Pharmaceutical **** Others Resident FCM +, + + Medical student. We have helped
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* Uxia Gutierrez Couto. Librarian. Ferrol
* Assumption Rosado. Family doctor. Madrid
* Marisol Galeote. Pharmaceuticals. Extremadura
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