Mobile clinics and home visits in Israel

  A multi-faceted and proactive approach that includes deploying mobile clinics and home visits where necessary has helped to ensure that the majority of patients with retinal disease are still receiving treatment during the COVID-19 pandemic in Tel Aviv, Israel, according to Anat Loewenstein MD. Speaking during a special webinar organised by the Intravitreal Expert Group, Prof Loewenstein, Full Professor of Ophthalmology at the Sackler Faculty of Medicine at Tel Aviv University, said that her department has managed to maintain patient care despite widespread disruption caused by the virus. “Israel took very strict measures at the beginning of the pandemic so we have been doing pretty well with quite a low mortality rate compared to some other countries. In terms of healthcare, all elective procedures were postponed and we organised the staff into separate teams so that one-third of the staff was present and working at any one time. This helped to limit the risk of infection,” she said. From the early stages of the pandemic, Prof Loewenstein’s team contacted patients in order to identify the more urgent cases and determine the best treatment strategy for each individual patient. “We took a few measures to try to ensure that everyone was covered. We offered telemedicine services for every patient for whom that was compatible. We continued emergency surgeries and also intravitreal injections. We did this in three ways: by bringing patients into the clinic but with extra hygiene measures in place and visits spaced out to limit contact. We did everything as quickly as possible once they were in the clinic. Where possible, we also switched patients from PRN and treat-and-extend to fixed regimens so there was no need to perform OCT,” she said. Another strategy was to set up a remote clinic outside the hospital thanks to a donation from a private company. “This enabled us to provide all the necessary equipment off site and to limit the contamination risk to the hospital. Once the structure was in place, the physician would go to the mobile clinic and administer the intravitreal injections there,” she said. The most ground-breaking step, however, was to bring treatment directly to the patients at home. “This was quite revolutionary. We all wore protective gear and treated each patient as if they were COVID-19 positive and we were able to administer dozens of injections daily in this way in the patients’ homes. We gave priority to elderly patients with limited mobility who could not come to the hospital or mobile clinic,” she said. Overcoming patient fear With the immediate crisis now over, Prof Loewenstein said that the priority now is to ensure that all patients receive treatment. “Our ‘no show’ rate is about 25% and some of these patients risk losing vision because they are afraid to come to the hospital. In Israel there is a major media campaign to incite patients to come to the clinics for treatment and emphasising the measures that are put in place to ensure their safety. We need to be proactive, to contact the patients, reassure them and let them know that we have a safe environment for them in which to receive their injections,” she said.