PinnacleHealth - Rationing Care

Pinnacle Health

11/02/2022

Rationing care Because the disease is so transmissible, has a high asymptomatic carriage rate, the numbers of cases are expected to grow exponentially.

It is important with exponential growth to maintain good lines of communication with the PHO and DHB, and to be prepared to be flexible in the response.

70% of patients who are know they have the disease are expected to be able to manage the condition alone with minimal health care support.

20% will need regular monitoring.

10% may need some form of intervention.

Overall, the expectation for Omicron is that less than 1% of cases will need hospitalisation.

Rationalising care to focus on the most vulnerable is necessary to avoid the system being overwhelmed with caring for the worried well.

High risk groups identified by the MOH are: People with underlying medical conditions Underlying medical conditions include: • • • • • • • •

serious respiratory disease, including chronic lung disease and severe asthma serious heart conditions immunocompromised conditions severe obesity — a body mass index (BMI) of 40 or higher hypertension that is not well controlled diabetes that is not well controlled chronic kidney disease liver disease.

Many conditions and treatments can weaken a person's immune system, including: • • • • •

having chemotherapy or radiotherapy bone marrow or organ transplantation some blood cancers immune deficiencies including HIV infection immunity weakening medications such as high-dose corticosteroids and disease-modifying antirheumatic drugs.

Other people at risk: Those over 70 Older people, especially those who have underlying medical conditions, are more at risk of severe illness from COVID-19.

Residents of aged care facilities International evidence has shown that aged care facilities are prone to the quick spread of viruses like COVID-19.

Residents are more at risk of illnesses due to their age and they are also more likely to have underlying medical conditions.

Ethnic minorities International research has shown COVID-19 has a larger impact on ethnic minorities.

Māori, Pacific and some other ethnic minorities in New Zealand are at risk of poor outcomes from COVID-19, especially when there is: • • •

a higher rate of chronic medical conditions crowded housing difficulty accessing health care.

Pinnacle Health

11/02/2022

People who are pregnant and those who have given birth in the last 6 weeks We recommend people who are pregnant take extra precautions, as evidence shows they may be at greater risk of poor outcomes.

Smokers People with a history of smoking are more likely to have severe symptoms of COVID-19 and be admitted to intensive care.

Proactive Rationing of Care: The People MOST at Risk Practices may want to proactively contact the patients at MOST risk and tell them that if they develop symptoms, it is most important for them to seek a test and inform the practice so their progress can be monitored.

To do this: The Covid Clinical Dashboard practice could identify and risk stratify their practice population, in the “details” report: The most vulnerable are those with the highest number of risk factors: • • •

Use the “Tier 3” filter to identify those patients at clinical risk of disease progression who were eligible for vaccination early on in the vaccination programme Use the ethnicity filter to identify all those in this group who are Maori / PI Select within this group those who are unvaccinated “dose 1 given – NO”

The list can be used to email, phone and / or text those people for a conversation.

Practices may choose to contact all Tier 3 patients.

The people LEAST at risk.

Patients who are in the lowest risk category are likely to be able to manage with self-care alone but need to know what to do if symptoms escalate.

Government information is available to tell all people to “Be Prepared” but practices may wish to promote this to their patients directly. Our patients trust us, and some will take more notice of a direct contact from you when the messages from the government will go in one ear and out the other.

Practices may wish to email, post, or promote via social media resources from the unite against covid website and health navigator to their patients.