Authors (including presenting author) :
Siu PY(1), Wong TK(1), Yau LM(1), Chan PF(1), Cheung YN (2), Mok PH(2), Kam YW(2), Chao DVK(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, United Christian Hospital (UCH) (2)Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
The UCH FMSC currently provides care to type 2 (T2) diabetes mellitus (DM) patients downloaded from UCH General Medical Clinic (GMC). They carry significant degree of DM complexity or co-morbidities which might not be feasible to be managed in General Out-patient Clinics. In the past, patients with deteriorating diabetic control or complications which required medical specialist care would be referred back to GMC first for initial care and then to DACC if needed. With increasing patient load, waiting time for such pathway could be up to 2 years. The reverse pathway to discharge patients with stabilized DM control from DACC to GMC and then to FMSC had similar waiting time. In order to better match the level of care to disease complexity for T2DM patients within reasonable waiting time, UCH launched a programme with fast track direct referrals between FMSC and DACC in 2017. Clear and specific referral criteria were established before implementation.
Objectives :
To evaluate the effectiveness of this programme.
Methodology :
Data on all patients exchanged between DACC and FMSC from 1st Feb 2018 to 30th Jun 2018 were analysed.
Result & Outcome :
There were 36 and 23 first attendances at DACC and FMSC respectively. Duration of DM was significantly longer for patients referred to DACC (Mean 21.4 years of patients referred to DACC vs 8.8 years of those referred to FMSC, P< 0.001). Median waiting time for first appointment was 3.6 months to DACC and 3.5 months to FMSC. HbA1c was significantly lower after referring to DACC (P value < 0.001) with mean HbA1c dropped from 10.3% to 8.8% after average of 2.9 consultations. Systolic blood pressure (SBP) was significantly lower after referring to FMSC (P value < 0.001) with mean SBP dropped from 143 to 129 mmHg after average of 2.4 consultations, possibly due to opportunity for more frequent drug titration. This programme provides more timely and better-matched level of care for T2DM patients in DACC and FMSC. Improvement of clinical outcomes were shown on both groups of patients. Collaboration between Family Physicians and Diabetologists contributed to a more efficient interface between primary and secondary care.
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