ABSTRACT
Background: Worldwide, COVID-19 pandemic lockdown lead to disruptions of general health services and neurological services in particular. Hence, it is essential to report to the scientific community regarding the nature and range of psychiatric social work services provided for neurology patients during the pandemic lockdown. Aim: To study the profile of patients availed psychiatric social work (PSW) consultation during pandemic lockdown at neurology in-patient setting. Materials and Methods: The study was retrospective in nature. Data were analysed from an in-patient referral registry. For the study purpose, neurological patients referred from April 2020 - June 2020 were considered. All patients referred for psychiatric social work consultations were included in the study. The study was carried out in tertiary care teaching hospital. Frequency and percentages were used to analyse the data. Results: The diagnostic profile revealed Stroke (40%), Guillain-Barré syndrome (10%), meningitis (10%), autoimmune encephalitis (4%), and demyelination (4%), other chronic neurological disorders (30%). Common psychiatric social work services provided were casework with caregivers and patients regarding education about the illness, breaking the bad news, grief interventions, supportive therapy, addressing child care issues, ensuring medication compliance and follow-up services, pre-discharge counselling, assessing socio-economic condition to facilitate financial assistance towards concession in hospital charges, facilitating social welfare benefits, and tracing the family members. Conclusion: Stroke, Guillain-Barré syndrome, neuro-infections were the most common neurological disorders required psychiatric social work consultations. Educating the patient and their family about the illness, facilitating welfare benefits and financial assistance were the most common psychiatric social work services provided during the covid-19 pandemic lockdown.
ABSTRACT
Introduction: Healthcare systems are struggling to cope with the rapid evolution of the COVID-19 pandemic. In Argentina, the pandemic is advancing despite prolonged lockdown measures. We aim to analyze the impact of the easing of lockdown measures in the number of visits to the emergency department (ED), and outpatient consultations (OC) to a tertiary neurological center. Methods: We compared the number of ED visits with the social mobility overtime. We also compared the number of OC, and the geographic distribution of patients' addresses between 2019 and 2020. Results: ED visits decreased 48.33% (n = 14,697 in 2019 vs. n = 7,595 in 2020). At the beginning of the lockdown, the social mobility decreased in pharmacies/groceries, and workplaces, along with a reduction in the number of ED visits. With the easing of lockdown restrictions, the social mobility decreased in residential places, slightly increased in workplaces and almost return to normal in pharmacies/groceries. Variations in ED visits correlate better with social mobility in workplaces (coef. =0.75, p < 0.001) than in groceries/pharmacies (coef. =0.68, p < 0.001). OC decreased 43%. Fourteen percent of OC were tele consults. This was associated with an increase of the geographical area of influence of our center (standard distance of 109 km in 2019 and 127 km in 2020). Conclusions: Despite an increase in social mobility, the number of ED visits and OC to an Argentinian tertiary neurological center remain worrisomely low. The pandemic catalyzed the introduction of telemedicine in our country. This has also allowed patients from distant zones to gain access to specialized neurological care.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS: A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS: Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION: The key informant survey identified the foreseeable changes in neurological care after the pandemic.
Subject(s)
Coronavirus Infections , Health Care Surveys , Nervous System Diseases/therapy , Neurology/trends , Pandemics , Pneumonia, Viral , Administrative Personnel/psychology , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Clinical Trials as Topic/methods , Consensus , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Management , Distance Counseling , Forecasting , Hospital Departments/organization & administration , Humans , Nervous System Diseases/diagnosis , Neurologic Examination , Neurology/methods , Neurology/organization & administration , Pandemics/prevention & control , Patient Isolation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Spain/epidemiologyABSTRACT
INTRODUCTION: The COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic. DEVELOPMENT: We report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures. CONCLUSION: Despite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.