Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Global Health Partnerships, Health Education England, London, UK.
BMJ Glob Health. 2024 Oct 22;8(Suppl 6):e014695. doi: 10.1136/bmjgh-2023-014695.
The COVID-19 pandemic presented a significant challenge to health systems worldwide, requiring resources to be directed to the pandemic response while also maintaining essential health services. Those with non-communicable diseases (NCDs) are particularly vulnerable to COVID-19, and interrupted care resulting from the pandemic has the potential to worsen morbidity and mortality.We used narrative literature review and key informant interviews between August 2021 and June 2022 to identify how NCD services were impacted during the pandemic and which good practices helped support uninterrupted care.On the background of an existing strong healthcare system, Thailand exhibited strong central coordination of the response, minimised funding interruptions and leveraged existing infrastructure to make efficient use of limited resources, such as through mobilising healthcare workforce. A key intervention has been redesigning NCD systems such as through the 'New Normal Medical Services' initiative. This has promoted digital innovations, including remote self-monitoring, patient risk stratification and alternative medication dispensing. Emphasis has been placed on multidisciplinary, patient-centred and community-centred care.NCD service utilisation has been disrupted during the COVID-19 pandemic; however, newly adapted efforts on top of existing robust systems have been critical to mitigating disruptions. Yet challenges remain, including ensuring ongoing evaluation, adaptation and sustainability of redesign initiatives. This learning offers the potential to further positive health systems change on a wider scale, through sharing knowledge, international collaboration and further refinement of the 'new normal' model.
COVID-19 大流行给全球卫生系统带来了重大挑战，需要将资源用于应对大流行，同时维持基本的卫生服务。患有非传染性疾病（NCD）的人特别容易受到 COVID-19 的影响，大流行导致的护理中断有可能使发病率和死亡率恶化。我们使用叙述性文献回顾和 2021 年 8 月至 2022 年 6 月之间的关键信息者访谈，确定了 NCD 服务在大流行期间受到的影响，以及哪些良好做法有助于支持护理不间断。在现有强大的医疗保健系统的背景下，泰国表现出了对应对措施的强有力的中央协调，最大限度地减少了资金中断，并利用现有基础设施高效利用有限的资源，例如通过调动医疗保健劳动力。一个关键的干预措施是重新设计 NCD 系统，例如通过“新常态医疗服务”倡议。这促进了数字创新，包括远程自我监测、患者风险分层和替代药物配药。重点是多学科、以患者为中心和以社区为中心的护理。NCD 服务在 COVID-19 大流行期间受到了干扰；然而，在现有强大系统之上新采取的适应措施对于减轻干扰至关重要。但挑战仍然存在，包括确保重新设计举措的持续评估、适应和可持续性。这一学习为更广泛地进一步积极进行卫生系统变革提供了潜力，方法是分享知识、开展国际合作和进一步完善“新常态”模式。
