Who is entitled to a 48-hour home visit? «Father was offered a deadline in 8 days. I heard there are no doctors »

Mrs. Anna and her 73-year-old dad have COVID-19 and have been in quarantine since January 31. – I called the clinic, at least asked for a teleportation for my dad. We are officially quarantined until February 9. First date? February 8 – adds a resident of Warsaw’s Żoliborz. – I heard that there are no doctors, I can’t count on a visit at home. I was able to beg teleportation on February 3. I don’t think it should be like this.

1. The new strategy for fighting the coronavirus assumes that a doctor is obliged to examine every patient over 60 years of age with confirmed COVID-19. It has 48 hours to do so. from the patient being informed of the infection
2. The patient must be physically examined, which means that the doctor must meet with him to check his health. The physical examination consists, among other things, in on auscultation of the patient, which excludes telephone consultation
3. So much in theory. In practice, however, this issue raises a lot of doubts. One of them is where you get medical advice. So who is entitled to a home visit? When should it take place? Can a patient leave the quarantine to reach the clinic? 
4. Contrary to appearances, this visit does not have to take place at the patient’s home. If the patient’s condition enables him to move around and reach the clinic, the examination is carried out in the primary health care facility
5. More information can be found on the Onet homepage

MedTvoiLokony editors receive letters from readers who have doubts about how to enforce the new right of people over 60 in practice. The most common questions include the conditions that must be met in order to take advantage of such a visit. Readers also ask if they (or their parents) have advice when they are in quarantine. The place of the visit raises doubts – whether the doctor will come home to check the patient or whether the senior has to go to the clinic.

Our reader, Ms. Anna, tried to arrange a home visit for her father who had COVID-19. The man is 73 years old, both of them are in quarantine. Waiting time: 8 days. – I heard that there are no doctors, I can’t count on a visit at home. I don’t think it should be like this.

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Who is the “48-hour test” for?

Pursuant to the ordinance of the Minister of Health of January 24, 2022, people infected with the coronavirus can count on medical advice including a physical examination, i.e. a physical examination.

Such a test is available to people who:

1. are 60 years of age or older,
2. are in isolation,
3. they are insulated at home.

Isolation is a particularly important condition for obtaining such advice. In practice, this means that physical examination is only available to those people whose SARS-CoV-2 virus infection has been confirmed by a PCR test and its result is in the official system. This visit does not apply to people in quarantine.

What is a physical examination?

A physical examination is part of a general examination to diagnose any medical conditions and check the general health of the patient. It consists of four elements: palpation, percussion, tapping and auscultation. Such research allows, among others determine the size and location of certain organs.

In the case of physical examination of patients with COVID-19, the doctor can, for example, identify disorders in the respiratory system, including bronchioles, bronchi and lungs. During such an examination, he may also feel various kinds of tension and swelling.

The rest of the text below the video.

When should this advice take place?

The regulation specifies precisely when such a senior examination should take place. The advice is to be carried out “not later than 48 hours of this isolation”. If, on the other hand, “the time limit for consulting expires on a statutory day off work or on a Saturday, the consultation takes place on the next day, which is not a public holiday or a Saturday”.

So if a person aged 60 and over receives a positive PCR test result on Tuesday, the test should take place on Thursday at the latest. However, if COVID-19 is officially diagnosed on Thursday, the visit may not go ahead on Monday at the earliest.

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Does the visit have to be made at home?

Although the patients themselves refer to home visits in relation to the new pandemic strategy point, the senior’s examination does not have to take place in his home. If the patient is able to reach the clinic on his own (his physical condition allows him to do so), the physical examination should take place in the primary health care facility.

Of course, The date of the visit is set individually with such a patient. Most of the covid clinics admit patients after performing other services, such as laboratory tests, diagnostic tests, vaccinations or consultations for patients with chronic diseases, other diseases and ailments that do not suggest coronavirus infection. Therefore, you should not come to the primary health care center without a scheduled consultation date, so as not to expose other patients to contracting SARS-CoV-2.

What if the senior cannot reach the clinic?

The regulation reads: “In the case of a patient who is not able to move independently or whose health condition justifies it, doctor in a medical entity specified in the list drawn up and maintained on the basis of an order issued by the minister competent for health issues pursuant to Art. 11 h of paragraph 2. 2 point 2 of the Act of March 2020, 19 on special solutions related to the prevention, prevention and combating of COVID-1, other infectious diseases and crisis situations caused by them as part of the activities referred to in paragraph XNUMX, orders him to be transported to the place of isolation or isolation at home or in a hospital ».

In practice, however, the doctor most often goes to the patient’s home by himself, arranging transport on his own. This situation was illustrated in an interview with Medonet by a family doctor from Wrocław, MD Anna Krzyszowska-Kamińska:

Bow. Anna Krzyszowska-Kamińska

If a patient calls me and says that there is no way to get to me, I have to go see him. And this is the whole trip. More than once, I went to a home visit disguised as an alien, to the delight of the people in the windows. I get out of the car, change my clothes, everyone is happy. I am not an ambulance, so I cannot park close to the patient, especially since we have a lot of ghetto-type housing estates, fenced, it is impossible to enter there without authorization. So I park where I can, sometimes in the parking lot of some hypermarket, and then I rush from there in a jumpsuit like Santa, through the estate. Chat has a use.

In practice, owned by the doctor, covid patients are admitted after 17. If patients call with information that they have been diagnosed with coronavirus infection and need a medical consultation, they are invited to the clinic in the evening. If their condition requires a quick response, they are invited to a separate office where only COVID-19 patients are admitted.

– We have set up a curtain for quick antigen tests. When it comes out positive, the person who tested, of course properly protected, examines the patient, measures the saturation, pressure, heart rate, collects a detailed interview and evaluates it. If the patient is in such a condition that he can safely go home, we send him there and ask him to come back around 18pm., poorly equipped – a couch, table, chair, computer – so that it can be cleaned and aired as soon as possible – he says.

Doctors about examining a senior within 48 hours.

The medical community did not accept the new ordinance of the Minister of Health with enthusiasm. Most of the medics did not hide their skepticism, stating directly that the examination of people over 60 within two days of diagnosis is pointless.

Bow. Jacek Gleba, an internist, pediatrician and family doctor: – In my opinion this is nonsense. After all, positive patients are very different. There are symptomatic patients who require urgent treatment, there are moderately symptomatic patients who need treatment within 24 hours, and there are patients who should stay at home and not go anywhere.

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Bow. Małgorzata Stokowska-Wojda, internist and family doctor: – The minister allowed himself to say that we can do it after 18. And that a little more goodwill is needed. I think that we have a lot of good will, it is difficult to accuse us of its lack. I felt as if I needed a ministerial decree for me to examine these patients. That’s what it sounded like.

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– We have been doing for a long time what the minister says at press conferences. It looks as if the Minister of Health has no idea how clinics work, what we are doing there. This is a serious undermining of confidence in us. I do not know what it is for – he adds.

Bow. Anna Krzyszowska-Kamińska, family doctor– We have always tested those who required it, and now I will test those who are positive, even if they have almost no symptoms. It can turn you crazy. I must admit that we are appalled by this regulation, it disorganizes our work a lot. Until now, we have been able to decide for ourselves which patient requires our intervention, and this choice is not always so obvious.

– Why should age be a criterion when choosing patient care? The examination in the first stage of the disease does not bring anything in, because at the beginning the viral infection is almost undetectable. What can we see there? A little red in the throat, auscultationally most patients are clear. Only when it becomes bacterially infected can I recognize bronchitis or pneumonia. Most often, interstitial pneumonia is not heard under a stethoscope, he explains.

A firm position of the medical community

Bożena Janicka, president of the Alliance of Healthcare Employers (PPOZ), also referred to the matter. In a letter to the Minister of Health, Adam Niedzielski, he writes, inter alia, that “the provision obliging GPs to directly assess the health of patients 60+ staying in isolation, there is no medical or epidemiological justification ».

1. Also read: Doctors want the minister to withdraw from the ordinance. Otherwise POZ in Poland “a catastrophe awaits”

According to PPOZ other COVID-19 patients, but also those suffering from other diseases, will pay for visits to seniors who do not require consultations. The new regulation makes it difficult for them to access health care and puts their health at risk.

– The expectation that a GP will be able to magically reorganize his work so that there is time to admit such patients is difficult to treat otherwise than in terms of wishful thinking: in primary health care there are no more manpower reserves to provide additional benefits – it was indicated, appealing to the minister to change his position on this matter, otherwise “primary health care in Poland will be faced with a catastrophe that will have a direct impact on the life and health of Polish patients”.

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