The order of the Minister of Health on changes to the standards of teleconsultation in primary care was published on March 8. According to it, patients can choose the form of consultation, remote or in-facility, while children under the age of 6 years is the only group prohibited for remote consulting. The order came into force on March 15.
As the Ministry of Health stated, the changes made will contribute to the rational use of teleconsultation and facilitate their systematization. The new standard is also expected to reduce the abuse of electronic visits in cases where the service must be provided in direct contact with medical personnel.
The medical community have been arguing on some statements of the draft order, which was the reason for it to take longer to be adopted.
The earlier version of the draft order allowed electronic appointment since March 1 only to patients aged 7 to 64, with some exceptions. However, physicians and patients found such age restriction limiting patients’ rights and constraining access to therapists and family doctors.
According to the order, in-facility appointment shall be carried out at the patient’s request. Moreover, it is mandatory for children under the age of 6 years old suffering from chronic diseases, in case of deteriorating condition of a patient or symptoms changed. At the same time, monitoring consultations during the treatment of a child may still be carried out remotely.
In addition, teleconsultation is prohibited at the first visit of a patient with suspected malignant neoplasm while for patients with suspected SARS-CoV-2 the visit will be remote in any case.
The changes in the standards for the provision of telemedicine services were result of the abuse of this form of services by some polyclinics leading to patients’ complaints, according to the reports of the Patient Ombudsman. In 2020, they reported problems with increased waiting times for medical services, pointed to the poor quality of telephone consultations, and questioned the effectiveness of teleconsultations as a form of treatment.
The analysis of the Office of the Ombudsman for Patients’ Rights indicates that the problem raised sharp in large cities. Often, patients were not able to get in-facility appointment with a doctor, could not reach the medical consultant via phone or access the facility when coming.
Let us describe a practice of a proper teleconsultations for an adult patient in case of their established communication. A patient sends an SMS request to his family doctor in case if he needs a prescription or sick leave, including reasonable facts for the doctor’s approval. The doctor may clarify some points via phone call or send the patient e-prescription or e-sick leave number if the request is clear.
Let’s say, a patient needs a shot against hepatitis B, diphtheria, tetanus or another infection. In this case, a patient sends an SMS request to the family doctor, who is expected to schedule the time of the vaccination in his office. We do not consider vaccination against SARS-CoV-2 here, as this procedure is carried out in accordance with the National Plan.
In case of a suspicion of a malignant neoplasm, the doctor schedules the patient in-facility appointment time, in respond to his SMS request. During a personal visit, the patient must be examined and receive prescription of treatment and additional medical tests.
We described the procedures of teleconsultations based on our personal experience. To get access to free medical care every person in Poland must sign a contract with a family doctor. The procedure is mandatory for doctors as well. Sure, we as doctors can quicker find a common language with our family doctors, in compare to a random patient. The communication with the “family doc” soon becomes friendly and he always accepts a personal visit, writing a prescription or giving a sick leave with no extra questioning.