Remote care: An insider’s guide to Thailand’s Covid-19 success story
Phra Nakhon Si Ayutthaya Hospital is one of many Thai hospitals that have partnered with the National Health Security Office (NHSO) and Public Health Ministry to pilot a home/community isolation programme for Covid-19 patients.
Located in Ayutthaya province, north of Bangkok, the hospital provides care to more than 3,000 coronavirus patients under isolation.
Currently, around 300 new cases are reported daily in the province. As of August 30, there were 7,634 active cases and 13,264 who had recovered.
Dr Chokchai Leetochawalit, director of Phra Nakhon Si Ayutthaya Hospital, said his hospital had joined the home/community isolation programme when it launched on July 12.
"We struggled a bit at the beginning as we had to find a way to adapt to remote care. But we learned to improve along the way thanks to the NHSO guidelines," he said.
More than 90 per cent of Covid-19 patients in Ayutthaya city are either under the home/community isolation programme or receiving intensive care at hospitals.
Home isolation provides a hybrid of virtual and on-ground care to patients. Hospital staff monitor them via online consultations while providing medicine, medical devices, and meals via home delivery service.
Community isolation involves members of communities or local administrative organisations who manage community isolation facilities for Covid-19 patients unable to isolate themselves at home.
The programme is driven by resource-sharing among different players in the Thai health system – from the central and local governments, state and private hospitals, clinics and pharmacies to local communities – to provide care to patients while curbing the spread of coronavirus.
To join the home/community isolation programme, said Dr Saowalak Chaoponetong, assistant hospital director, each Covid-19 patient must first have a chest X-ray.
This helps hospital staff evaluate the patients' condition and ensure they will not develop severe symptoms when isolating at home or in a community facility.
While under isolation, each patient will receive medicines – including green chiretta (fah talai jone) capsules, pain relievers, runny-nose and cough medicines, a thermometer, a finger pulse oximeter, and a kit containing items for daily use.
Within two days of testing positive, they will get food deliveries managed by the hospital staff. Phra Nakhon Si Ayutthaya Hospital is also distributing antiviral favipiravir to community-level hospitals in its network for new cases within 24 hours of detection.
To monitor patients remotely, Dr Saowalak said that her staff are providing virtual consultations to patients via COVID Tracker, a telemedicine software developed by Precision Dietz Co Ltd.
The patients must measure their temperature and oxygen level with the medical devices provided by the hospital staff and report the results online twice a day – at 9am and 3pm. They must also fill out a short online form to report their symptoms daily.
These results are collected in the hospital database and used to analyse and classify patients, allowing hospital staff to monitor thousands of patients simultaneously.
The computer system alerts hospital staff if the data shows any patient has developed more severe symptoms. These patients are then transferred from their homes to hospital immediately.
"Along with data, the strength of the primary care network is a crucial factor that helps us to run the home/community isolation programme effectively," said Dr Saowalak.
"Our staff are collaborating and working together with family doctors and health workers at community hospitals to monitor patients under isolation. These community healthcare workers help us to assure local community residents that home/community isolation is not scary and will not spread the disease to whole communities," she added.
"The home/community isolation programme is the solution for our health system that is currently having to handle a spike in coronavirus cases under constrained resources," said Dr Athaporn Limpanyalers, NHSO deputy secretary-general.
"It also helps free beds for moderate and critical patients who need intensive care in hospitals."
However, despite the success story of Phra Nakhon Si Ayutthaya Hospital, the programme still has room for improvement.
Dr Peera Areerat, Ayutthaya provincial public health chief, said that the programme might cost extra for some hospitals, which have already experienced liquidity problems.
He urges the government to distribute funds to provincial organisations or local governments that understand the healthcare context and challenges on the ground, so they can allocate budget to hospitals directly and efficiently.
"The NHSO will do everything it can to support local organisations and health workers," said Dr Athaporn.
Meanwhile, the NHSO has adjusted its claim system in recent months, adopting artificial intelligence in auditing to hasten claim-document reviews and transactions. It is also working with IT developers to pilot a QR Code authentication system that will reduce hospital staff's workload by making patients’ verification easier and quicker.
In addition, the NHSO has recruited licensed private clinics, including beauty clinics, to take part in the home isolation programme. They will provide care and remote consultation to Covid-19 patients and guidance for individuals on how to use Covid-19 antigen test kits.