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Challenges to improve the Coronavirus disease 2019 (COVID-19) Immunization among dialysis population in Hamad General Hospital in the Nephrology Division, Hamad Medical Corporation, Doha, State of Qatar
Background: Hamad General Hospital (HGH) Nephrology Department is the main provider for dialysis services in Qatar serving almost 900 patients. The introduction of the COVID-19 vaccination is a crucial step in protecting End Stage Renal Disease (ESRD) patients who are vulnerable and prone to infections due to their immunocompromised status.1 They are at high risk because they are unable to practice adequate safe physical distancing as the majority of them are dependent on others due to age and the medical condition.
During the first wave of the COVID 19 pandemic the mortality rate was 20-30% among the dialysis population.2 Several challenges were faced since February 2020 to manage and control COVID-19 infection in dialysis units. Vaccination is the most important preventive measure in facing COVID-19. Hence a multidisciplinary team was formulated in March 2020 aiming to raise the patients and staff awareness of the importance of COVID-19 vaccination. Methods: The assessment of dialysis patients’ knowledge and educational needs was done by conducting multidisciplinary focus group activities providing educational materials in many languages education through hospital TV channels WhatsApp group activities with patient educators and direct education during physicians’ monthly dialysis assessment. Monitoring the compliance rate was done by monthly data collection and targeting non-compliant groups. Results: After the implementation of COVID-19 immunization strategic plan by the end of June 2021 75% (666 patients) out of 884 dialysis patients were vaccinated (Figure 1). The current vaccination update for over 16-year-old in Qatar is 62.8% 3. Moreover COVID-19 positive patients were properly managed since the beginning of 2020 by following Ministry of Public Health (MOPH) guidelines to control the spread among the dialysis population and the successful initiation of COVID-19 vaccination program (Figure 2). Conclusion: Continuous educational activities and awareness campaigns have increased COVID-19 immunization percentage among the dialysis population and probably contributed to saving lives.
Impact of COVID-19 on dialysis patients: Reported experience in Qatar
Background: Patient-centered care is a concept focussing on meeting the specific health needs of patients as expressed by them. Patients Reported Experience Measures (PREM) is another concept associated with patient-centered care. PREM surveys capture information about the healthcare experience as perceived by patients.1 Its importance lies in the incorporation of patient feedback into the clinical decisions and service evolution.2 Dialysis patients play an important role in their treatment and their voice matters to provide proper care. PREM was first conducted in 2019 in our dialysis unit. In 2020 the COVID-19 impacted dialysis services and resulted in many challenges including staff shortage and deployment. Yet the patients’ feedback was evaluated continuously and compared with previous years before the pandemic. Methods: A validated questionnaire from the National Health Service in London was used.3 It consisted of 7 questions covering demographics dialysis options patient portal patient's relationship with the staff teamwork and traveling abroad. The survey involved 317 randomly selected patients who have been at least one year on dialysis. A comparison between 2019 and 2020 results was conducted using the chi-square test. Results: A drop in patients’ experience was observed in many survey components like education on dialysis medication side effects access to the patient portal access to physicians and nurses from home (Figure 2). However in other areas some positive experiences remained unchanged like communication and knowledge among the staff.:Conclusion: Patients’ reported experience helps in the evaluation of health services. After exploring dialysis patients’ experiences it was possible to identify what is going well and how COVID-19 impacted the patients’ perspectives. The PREM survey conducted in this work showed a significant decline in many parameters likely attributed to COVID-19 consequences including the staff shortages.