Improving access to health care in Lithuania during the pandemic

1 November 2021

Lithuania has a strong tradition of delivering family medicine-based primary health-care services through multidisciplinary teams. Primary health care is well recognized as the first point of contact within the health-care system, and plays an essential role in coordinating care and ensuring evidence-based clinical pathways. Before the COVID-19 pandemic, 57% of all outpatient consultations were with family physicians and 98% were through direct consultations.

During the pandemic, like other countries, Lithuania introduced strict public health measures including lockdown, physical distancing and limits to movement, making primary health-care services less available through face-to-face consultations. In response, the Ministry of Health introduced measures to quickly transform the service delivery model from direct to remote consultations and mobile services provided in people’s homes.

Lithuania serves as a good example of rapid transformation, adjustment and agility, all of which have enabled primary health care to contribute to strong public health measures while also ensuring a dual-track response to the pandemic.

Overall, the challenges of the pandemic have served as a good opportunity to scale up the remote delivery of primary health-care services by multiprofile teams, including for people with complex health needs and for those with COVID-19.

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The Family Medicine Centre (FMC) at Kaunas Clinics serves a population of around 12 500 inhabitants. It provides comprehensive primary health-care services, including in homes and in care institutions, through a team of family doctors, advanced and community nurses, social workers, physiotherapists, a lifestyle specialist, and midwives. Psychiatrist and psychologist services are available here, as well as so-called fever clinics and COVID-19 vaccination. The FMC combines clinical practice, national and international research projects, and scientific, educational and pedagogical activities. It is also the main and largest base for family medicine residency in Lithuania.

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During the pandemic, the FMC was fitted with temperature measurement devices and hand sanitizers at the entrance.

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A separate entrance and a one-way system in corridors were introduced for patients presenting with high temperatures and respiratory difficulties to help ensure strict infection prevention and control for those attending fever clinics.

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Registration and triage of patients for remote, online or home visits were mainly carried out online or via telephone calls. The number of calls increased substantially during the pandemic.

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All primary health-care team members, including family physicians, nurses, social workers, physical therapists, advanced nurse practitioners and lifestyle specialists, moved to remote consultations, as demonstrated here by resident family physician.

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A multidisciplinary team visits a long-term patient at home. The son of the patient greets the physiotherapist, social worker and advanced nurse. Direct consultations were possible after patients were triaged over the phone by primary health-care providers.

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A patient in his 90s with multiple disorders and without the ability to move or talk is visited by health-care staff, who also provide support and advice to relatives on available care and physiotherapist services.

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An advanced nurse from the Home Nursing Unit visits a family to discuss what is needed for the continuing care and treatment of a patient living at home.

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The pandemic necessitated revising team roles and responsibilities due to a massively increased workload. Nurses, for example, started to consult with patients directly over the phone and were involved in managing patients with chronic conditions and those diagnosed with COVID-19. An electronic prescription service was also expanded through a collaboration with family physicians and nurses.

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If remote consultations are here to stay, working space will need to be analysed and adjusted to make long hours behind computers comfortable for health workers.

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Advanced nurse Ms Ramutė Micevičienė shares a selfie, taken during one of the peaks of the pandemic in Lithuania, showing the full range of personal protective equipment (PPE) needed when visiting patients at home. As she recalls, “There was a lot of uncertainty and tension in the beginning. We were not sure what to expect. We were visiting patients at home and after our visits we had to take off the PPE in corridors, disinfecting the space around us. The way we worked completely changed.”

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Dr Ida Liseckiene is a health manager and practising family physician at the Family Medicine Clinic at the Lithuanian University of Health Sciences. She also sits on the committee for improving primary health-care services in the Lithuanian Ministry of Health.

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Dr Liseckiene shares her thoughts on what it has been like to work during the pandemic: “Life for family physicians hasn’t become easier during the pandemic. Usually we are also administrators and managers, and we have to do both to help patients who have COVID-19 and those who are chronically ill. It’s a huge change, I think, not just for all health-care systems, including primary-care services, but for medical personnel and especially society as well.”