Service Process Guidelines

The person goes to their family doctor.
The family doctor refers the patient to a pulmonologist or cardiologist.
The pulmonologist or cardiologist:

• refers the patient for blood gas analysis with at least a 3-week interval;
• prepares a statement for receiving oxygen therapy at home (oxygen concentrator) for the patient, indicating the gas composition in arterial blood and the required oxygen flow, and duration of use (hours per day), if, upon determining the blood gas composition twice with ≥ 3 weeks interval, it is found:
         ◦ chronic respiratory failure PaO2 ≤ 7.3 kPa (≤ 55 mmHg);
         ◦ chronic respiratory failure PaO2 ≤ 8.0 kPa (≤ 60 mmHg) and the patient is diagnosed with:

1. respiratory or cardiac disease with secondary polycythemia (hematocrit ≥ 55 %) or pulmonary hypertension, or peripheral edema, or nocturnal hypoxemia (SpO2 < 90 % for more than 30 % of the sleep period);
2. pulmonary hypertension.

In the statement for receiving the assistive device, the pulmonologist or cardiologist indicates:
   • the assistive device required by the person - oxygen concentrator for long-term oxygen therapy at home;
   • the results of blood tests conducted with at least a 3-week interval;
   • the required oxygen flow, and duration of use (hours per day);
   • other necessary information.

Information on how to provide oxygen therapy at home for subacute patients after discharge from a stationary healthcare institution.

The doctor providing stationary healthcare services to a subacute patient, whose overall health condition is stable and does not require 24-hour medical personnel supervision, and the patient is to be discharged from the stationary healthcare institution for further treatment under the supervision of a family doctor at their place of residence, but has been diagnosed with respiratory insufficiency:

• ensures the performance of blood gas analysis and oxygen titration before the patient is discharged from the hospital
• no less than seven working days before the planned discharge of the patient from the hospital prepares a referral “Oxygen therapy at home (outpatient service)” in the Unified Health Sector Information System (hereinafter - VVIS) for receiving oxygen therapy at home (oxygen concentrator), if an arterial blood gas analysis has been performed, which indicates:
• chronic respiratory insufficiency PaO2 ≤ 7.3 kPa (≤ 55 mmHg);
• chronic respiratory insufficiency PaO2 ≤ 8.0 kPa (≤ 60 mmHg) and the person is diagnosed with:
         ◦ respiratory or cardiac disease with secondary polycythemia (hematocrit ≥ 55 %) or pulmonary hypertension, or peripheral edema, or nocturnal hypoxemia (SpO2 < 90 % for more than 30 % of the sleep period);
         ◦ pulmonary hypertension.

In the referral, indicate: 

• the note “SUBACUTE”;
• the gas composition in arterial blood and the diagnosed diseases;
• the required oxygen flow and duration (hours per day);
• the contact information of the patient or the patient's representative (patient's phone number, representative's first name, last name, phone number, contact person or referring doctor's phone number from the referring healthcare institution);
• the address where oxygen therapy at home should be provided;
• the planned start time and duration of oxygen therapy, considering that this service is paid from the healthcare budget for up to 3 months.

IMPORTANT! No less than seven working days before the planned discharge of the patient from the hospital, agree on the process of receiving the oxygen concentrator by contacting the NRC Vaivari coordinator, tel: 66 955 665 or by email: skabeklis@nrc.lv.

NRC Vaivari coordinates and delivers oxygen therapy at home (oxygen concentrator) for subacute patients no later than the next working day after discharge from the stationary healthcare institution.

• If it is expected that the patient will need therapy interruption or correction within 3 months, additional information is entered into VVIS or a discharge/statement is issued to the patient, indicating the period when the patient should consult a family doctor for a review of oxygen therapy at home;
• If it is expected that therapy is planned for longer than 3 months, upon discharge from the hospital, a referral is entered into VVIS for a pulmonologist or cardiologist, indicating that a visit is needed within 3 months (considering that the patient needs time to receive the service in order), to review the continuation of oxygen therapy as a chronic patient.

Provision of oxygen therapy at home for subacute patients receiving palliative care mobile team services or hospice care at home. 
A person providing palliative care mobile team services or hospice care at the patient's home for a subacute patient receiving hospice care at home and diagnosed with respiratory failure:

• provides pulse oximetry measurement; 
• no later than the next working day after pulse oximetry measurement prepares a referral “Oxygen therapy at home (ambulatory service)” for VVIS oxygen therapy at home (oxygen concentrator) if it is found that the SpO2 reading at rest, breathing ambient air is ≤ 90% and breathing oxygen target SpO2 ≥92%, if this cannot be achieved, then SpO2 ≥90% or SpO2 increase ≥4%;

The referral indicates:

• the note “HOSPICE CARE PATIENT”;
• blood oxygen saturation at rest, not breathing oxygen, measurement results;
• the required oxygen flow and time (hours per day);
• the patient's or patient's representative's contact information (patient's phone number, representative's first name, last name, phone number, contact person's or referring doctor's phone number from the referring medical institution);
• the address where oxygen therapy at home should be provided;
• the planned start time and duration of oxygen therapy.

IMPORTANT! No later than the next working day after pulse oximetry measurement, agree on the process for receiving the oxygen concentrator by contacting the NRC Vaivari coordinator, tel: 66 955 665 or by email: skabeklis@nrc.lv.

NRC Vaivari coordinates and delivers oxygen therapy at home (oxygen concentrator) for subacute patients receiving palliative care mobile team services or hospice care at the patient's home, no later than three working days from the day of receiving the referral.

The opinion for receiving home oxygen therapy (oxygen concentrator) is prepared by a pulmonologist or cardiologist.

For subacute patients, oxygen therapy is covered by the healthcare budget for up to 3 months, with no possibility of extending this period.

The referral must indicate the patient's status (SUBACUTE or HOSPICE CARE PATIENT), blood gas or SpO₂ values, required oxygen flow, duration of use, contact information, address, and the planned start time for therapy.

If it is expected that therapy will be needed for more than 3 months, when the patient is discharged from the hospital, a referral to a pulmonologist or cardiologist is prepared for the evaluation of the continuation of oxygen therapy.

Oxygen therapy is prescribed for hospice patients when SpO₂ at rest, breathing ambient air, is ≤ 90 % and, while breathing oxygen, the target SpO₂ is ≥ 92 % or at least ≥ 90 %, or the SpO₂ increase is ≥ 4 %.