Abstract
Introduction: Remote home monitoring of COVID-19 positive patients was initiated in January 2021 to offload the burden from hospitals to primary health care facilities in Malaysia. In May 2021, the involvement of private medical practitioners (PMP) in home monitoring was a crucial step in enhancing targeted primary health care within the community setting. The methodology of this collaboration is explained.
Methods: Various engagement sessions initiated by the Family Health Development Division were held with the main General Practitioner (GP) associations pertaining this new scope. This provided patients who tested positive for the SARS-CoV-2 virus with a choice of being monitored by their regular health care provider.
Interested GPs initially needed to be appointed by the Minister of Health as officers under the Prevention and Control of Infectious Diseases Act. This was to enable home surveillance orders (HSO) issued by GPs to be legally standing. Following the HSO issued, home monitoring of the positive cases followed a structured home assessment tool. For those with worsening symptoms, referral from GPs to hospitals or low risk treatment and quarantine centres was enabled [4]. A total of 1189 PMPs were appointed in 2021. The coordination between GP associations and MOH was crucial in enabling GPs voluntary participation. A not-for-profit, token fee of RM10 per patient per day throughout the mandatory home monitoring period incentivized GPs to offer home monitoring services. Those who opted not to receive payment from MOH were able to charge patients directly instead.
Guidelines for home monitoring were publicly available online. Some refinements to the guidelines included widening the pool of patients for home monitoring to new patients, temporarily waiving the need for patients to be the GPs existing registered patients, enabling virtual remote monitoring without the need for an initial face-to-face consultation and assessment, and relaxing the clinical criteria to include senior citizens aged >60 years.
Discussion: Successful home monitoring by GPs was reflected via an upward trend of the numbers of GPs involved, as well as the number of new cases monitored by them (Figure 1). However, GPs overall were underutilised as seen by limited numbers of those participating.
Some of the limitations hindering successful uptake by GPs was the need for reports to be sent to the nearest DHO, the nominal sum offered as an incentive, and the lack of a centralised system that would enable seamless registration, reporting, token sum payment, and referral of patients. GPs also had to cater to the burden of seeing both regular patients as well as scheduling appointments for COVID-19 positive patients. Conclusion and recommendations: Better collaboration could be initiated between DHOs and GPs at the local level. A third-party administrator to handle the implementation, monitor and incentivize GPs, with process automation and better self-regulation would help, besides better financial retribution. Theme 2 of the Twelfth Malaysia Plan, 'Strengthening Security, Wellbeing and Inclusivity ' mentions the inclusion of the private sector as a key component at the highest level. Thus, strengthening the cooperation forged during the pandemic is crucial.
Links
- https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-96.pdf
- https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed1909[...]
BibTeX (Download)
@proceedings{APCPH2022-P-96,
title = {Remote home monitoring of COVID-19 positive patients in Malaysia in year 2021 via a public private collaboration},
author = {Rajini Sooryanarayana and Asnida Anjang Ab Rahman and Naning Sachiman and Noridawaty Ibrahim and Nazrila Hairizan Nasir and Mastura Ismail and Rohani Jahis and Siti Nor Mat and Azizah Wahab},
url = {https://apcph.cphm.my/wp-content/uploads/2022/07/APCPH2022-P-96.pdf
https://apcph.cphm.my/wp-content/uploads/wpforms/1176-1e04940bb5d885bf8711ed19095a89ed/Abstract-Poster-RS-v4-f19b2f5d0670170f96d9975160405c80.pdf},
year = {2022},
date = {2022-08-02},
urldate = {2022-08-02},
issue = {7},
abstract = {Introduction: Remote home monitoring of COVID-19 positive patients was initiated in January 2021 to offload the burden from hospitals to primary health care facilities in Malaysia. In May 2021, the involvement of private medical practitioners (PMP) in home monitoring was a crucial step in enhancing targeted primary health care within the community setting. The methodology of this collaboration is explained.
Methods: Various engagement sessions initiated by the Family Health Development Division were held with the main General Practitioner (GP) associations pertaining this new scope. This provided patients who tested positive for the SARS-CoV-2 virus with a choice of being monitored by their regular health care provider.
Interested GPs initially needed to be appointed by the Minister of Health as officers under the Prevention and Control of Infectious Diseases Act. This was to enable home surveillance orders (HSO) issued by GPs to be legally standing. Following the HSO issued, home monitoring of the positive cases followed a structured home assessment tool. For those with worsening symptoms, referral from GPs to hospitals or low risk treatment and quarantine centres was enabled [4]. A total of 1189 PMPs were appointed in 2021. The coordination between GP associations and MOH was crucial in enabling GPs voluntary participation. A not-for-profit, token fee of RM10 per patient per day throughout the mandatory home monitoring period incentivized GPs to offer home monitoring services. Those who opted not to receive payment from MOH were able to charge patients directly instead.
Guidelines for home monitoring were publicly available online. Some refinements to the guidelines included widening the pool of patients for home monitoring to new patients, temporarily waiving the need for patients to be the GPs existing registered patients, enabling virtual remote monitoring without the need for an initial face-to-face consultation and assessment, and relaxing the clinical criteria to include senior citizens aged \>60 years.
Discussion: Successful home monitoring by GPs was reflected via an upward trend of the numbers of GPs involved, as well as the number of new cases monitored by them (Figure 1). However, GPs overall were underutilised as seen by limited numbers of those participating.
Some of the limitations hindering successful uptake by GPs was the need for reports to be sent to the nearest DHO, the nominal sum offered as an incentive, and the lack of a centralised system that would enable seamless registration, reporting, token sum payment, and referral of patients. GPs also had to cater to the burden of seeing both regular patients as well as scheduling appointments for COVID-19 positive patients. Conclusion and recommendations: Better collaboration could be initiated between DHOs and GPs at the local level. A third-party administrator to handle the implementation, monitor and incentivize GPs, with process automation and better self-regulation would help, besides better financial retribution. Theme 2 of the Twelfth Malaysia Plan, 'Strengthening Security, Wellbeing and Inclusivity ' mentions the inclusion of the private sector as a key component at the highest level. Thus, strengthening the cooperation forged during the pandemic is crucial.},
howpublished = {published online at https://apcph.cphm.my},
note = {Type: POSTER PRESENTATION; Organisation: Family Health Development Division, Ministry of Health, Putrajaya, Malaysia; Disease Control Division, Ministry of Health, Putrajaya, Malaysia; Public Health Development Division, Ministry of Health, Putrajaya, Malaysia},
keywords = {home monitoring, Malaysia, primary health care, public private collaboration},
pubstate = {published},
tppubtype = {proceedings}
}