Development of a continuity-of-care system for COVID-19 patients

Abstract

Abstract

            This action research aims to develop a continuity-of-care system for COVID-19 patients. The study was conducted from March to December 2021, and consisted of three phases: analysis, implementation, and evaluation. The development team consisted of 65 multidisciplinary professionals, and the sample group consisted of 871 discharged COVID-19 patients.
The research tools included: 1) a focus group discussion, 2) a draft of continuous care guidelines, 3) a follow-up care record form, 4) a knowledge database, and 5) a satisfaction assessment questionnaire. The quantitative data was analyzed using percentages, mean values, and standard deviations, while the qualitative data was analyzed using content analysis.

            The results of the situation analysis revealed that the continuity-of-care guidelines for COVID-19 patients were unclear, and there was a lack of facilities and equipment for care. Patients also lacked knowledge on self-care, healthcare staff lacked confidence, and the community did not accept patients. The researcher applied the framework of the World Health Organization's ‘Building Blocks' to develop the system, with pandemic emergency management policies in place. We established a team to provide continuous care management at the district level, created networks and sub-district rest centers, developed the capacity of multidisciplinary teams, prepared families and communities to receive patients, prevented the spread of further infection, provided care following the guidelines, coordinated patient transportations, provided nursing care, and referral of patients to specialists, as well as developing a telephone-based information system and communication channels to ensure patient access to necessary medication and equipment. The evaluation showed positive results. Every patient received continuous care according to the guidelines, and the majority showed improvement in their condition The rehospitalization rate was 0.44%. There were no community deaths. The community approval improved with satisfaction score from 74.06 to 96.22.  Suggestions for the development of health system show community participation should be focus on development of health framework and the guidelines for post-COVID care will need the clarification.

Keywords : continuity-of-care, COVID-19 patients, health system