Room 421 May 15, 2019 oral abstract
Service Enhancement Presentation 13:15 - 14:29

Enhancing Partnership with Patients and Community

Public Private Partnership (PPP) in Community Speech Therapy Service, HKWC
13:15 - 13:25
Presented by : David CHOW

Introduction

The Community Speech Therapy (CST) Service was started in 2001 in HKWC. The service provides outreach swallowing management by HA Speech Therapist (ST) to patients living in residential care home for the elderly (RCHEs) in cluster. Currently, 0.9 FTE ST is allocated in HKWC and provides services to 57 RCHEs. The allocated manpower is inadequate for the huge population in RCHEs and limits the quantity and quality of service delivery. In 2012, 3 RCHEs under The Hong Kong Society for the Aged (SAGE) in HKWC started to provide out-sourced private ST service by their funding. In 2013, 1 FTE ST was recruited by the institution. The scope of institution ST service overlapped with that of HA outreach ST. The swallowing aspects of the elderly were unavoidably managed by STs from two parties. It was foreseeable that frontline staffs of RCHEs would be confused when there were discrepancies on swallowing management. Meetings between HA ST, Community Care Service Team (CCST) and the management of SAGE were held in 2013. The following common goals were agreed: - Better utilization of public and private resources (Public Private Partnership) - Better communication of STs from both parties - Ensure the continuity of swallowing management from HA to institution There were consensuses on several areas: - The elderly would be managed by both HA ST and Institution ST together. - Information flow of patients swallowing aspect between both parties was guaranteed. - Logistic of overall workflow and referrals criteria were agreed.

Objectives

This pilot study aims to evaluate the treatment effectiveness of the new co-operated ST service delivery model to RCHEs in HKWC, where the swallowing management was provided jointly by HA outreach ST and RCHEs institution ST under the PPP framework.

Methodology

- Study design: Retrospective cohort study. - Participants: Patients aged 65 years or above, referred to HA CST service and living in the 3 RCHEs under SAGE. - Sampling period: July 01, 2010 – June 31, 2011 with HA CST service only, and July 01, 2016 – June 31, 2017 with PPP ST service. - Data source: Retrospectively collected from discharge summary on HA electronic patient record (ePR). - Descriptive data: Number of new attendance, number of follow-up attendance, average waiting time, and number of visit. - Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 and 12 months of the first HA CST appointment in RCHEs. - Statistical analysis: Effect measures by relative risk, absolute risk reduction, number needed to treat, 95% confidence interval whenever appropriate.

Results & Outcome

Descriptive data: Number of new attendance: 75 in period with HA CST service only, 104 in PPP ST service period Number of follow-up attendance: 88 in period with HA CST service only, 73 in PPP ST service period Average waiting time: 43.5 days in period with HA CST service only, 23.9 days in PPP ST service period Number of visit by CST: 21 visits in period with HA CST service only, 29 visits in PPP ST service period Primary outcome: Acute hospital admission rate with medical diagnosis of pneumonia within 3 months: - Relative risk = 0.618, 95% CI [0.391, 0.977] - Absolute risk reduction = 14.3% - Number needed to treat = 7.01 Acute hospital admission rate with medical diagnosis of pneumonia within 12 months: - Relative risk = 0.714, 95% CI [0.536, 0.951] - Absolute risk reduction = 18.6% - Number needed to treat = 5.36 Interpretation: - Statistically significant reduced risk of hospitalization due to pneumonia post 3-month and 12-month after first assessment for PPP ST service - Treating every 7.01 and 5.36 patients under PPP ST service would respectively prevent one adverse outcome of hospitalization due to pneumonia within 3 months and 12 months of first assessment

 

 

Patient perspectives on accepting immediate breast reconstruction treatment decisions: patient attitudes and preferences associated with breast reconstruction
13:26 - 13:35
Presented by : O K CHUN

Introduction

According to the SOMIP report, not all the hospitals under the Hospital Authority can perform immediate breast reconstruction operation. Having the option of immediate breast reconstruction for breast cancer patient is it consider as a privilege? However, when offered this option, patient may not take up the procedure. Therefore, exploring the patient attitudes and own preferences of life style can be a consideration affecting her own treatment decision.

Objectives

Retrospectively look into pretreatment life style and attitude of patient who had considered immediate breast reconstruction from 2016 to 2018.

Methodology

99 patients who had attended the “combined breast and plastic clinic” for assessment from 2016 to 2018 and records were reviewed. Their mean age was 48.5. 28.28% patients were ductal carcinoma in-situ and 66.67% were invasive carcinoma on diagnosis. Most of their education levels were secondary or above and most of them were middle social class. < 20% patients claimed they had friends who had breast reconstruction done or had used prosthesis after mastectomy. Most of our patients thought it was important to let all the breast cancer patients knew about breast reconstruction. However, 24% patients claimed even knowing about breast reconstruction information did not relieve the traumatic psychological morbidities of having breast cancer. Nearly 20% of patients afraid having breast reconstruction might block or blur the breast cancer monitoring and increase chance of recurrence in the future.

Results & Outcome

The records of breast cancer patients who had the choice of immediate breast reconstruction from 2016 to 2018 were reviewed. Every patient before attending the “combined breast and plastic clinic” for assessment was invited to fill a questionnaire about patient’s attitude and own preference on her daily activities. The focus of this retrospective review is to identify the concern that may influence the decision of immediate breast reconstruction. The results suggested there are psychological burden related to cosmetic outcomes, post-operative complications and surveillance. In our centre, only around 12% newly diagnosed breast cancer patients would have interested in discussion on immediate breast reconstruction and eventually, 2/3 of patients chose immediate breast reconstruction. Shared decision making and good information transfer were our strategies to facilitate patients with more confidence in clinical decisions.

 

 

Mobilizing the social capital of the community for neighbourhood support of elders on fall prevention at home
13:36 - 13:45
Presented by : FLORA KO

Introduction

Falls are a major cause of morbidity and mortality in the older population. Among the community-dwelling elders of age 65 and above in Hong Kong (HK), the fall rates range from 20%-30% and are higher after age 75 (Chu, Chi & Chiu, 2007; HKSAR, 2012). Among those who fall, about 75% would sustain an injury and admit to hospital or residential care home (HKSAR 2016). Falls are not a normal part of ageing. They do not “just happen” but are resulted from the interactions of biological, behavioural and environmental risk factors. Among these factors, home hazards play a significant role, associating with a 38% increased risk of falls (Letts, Moreland & Richardson, 2010). In preventing and reducing elderly falls and the fall-related morbidity and mortality, modifiable risk factors are intervened through behavioural and home-based environmental modifications with booster follow-up home visits to maintain the effectiveness (Chu, et al., 2017). Touching the northern boundary of HK, North District of the New Territories is a rural area with a population of 320,000 which North District Hospital (NDH) serves. Among the residents, 11.1% are elders and 20% are scattering in 117 villages where the traditional cultural habits of the region are the most maintained (HKSAR, 2015). As such and to be effective, the fall prevention interventions have to accommodate the remoteness of the elders’ residence as well as their unique cultural and daily living habits.

Objectives

To provide care-in-place for elders at risk of domestic falls, a medical-social collaboration project was put into pilot for two years to support safe living at home for the elder patients discharged from NDH. Home safety devices are installed and potential risks are eliminated to prevent falls and reduce injury severity such that hospital admissions due to falls at home were prevented. Follow-up on the implementation of the fall prevention measures prescribed by occupational therapist was supported through volunteers.

Methodology

Led by occupational therapists, care-in-place was realized by integrating medical and rehabilitation services with home care upon empowering a non-government organization (NGO) in the community such that the therapist-prescribed fall prevention measures were reinforced in implementation by and in the elder patients’ homes through the neighbourhood young-old volunteers of the local community. With this intersectoral collaboration, leverage was offered through pooling the expertise and resources of the hospital with NGO to generate better service in an accessible manner.

Results & Outcome

190 hospital-discharged elders aged 60–97 were served for six months or more in fifteen project months, with 57 (30.00%%) aged 60-75 and 133 (70.00%) aged above 75. 1,826 home safety devices of 32 types were delivered. 524 home visits were made by occupational therapist. 282 friendly visits were paid by volunteers, averaging to 1.5 visits per patient. Of the patients served, 3 died from medical illnesses. 26 (13.90%) reported falls at home, indicating a relatively lower incident rate than their well community-dwelling peers. Among these elders with falls, 22 (84.62%) were admitted to hospital. Being older (>70) and at the time just after discharge from hospital might pose them at a higher fall risk than their peers. Referencing to the global and local fall incidence of community-dwelling well elderly, the project outcomes were encouraging. Upon the support for safe living, the elders can enjoy life in their own natural home environment. Being familiar with the local culture and daily living habits, the project experience showed aptness of the young-old volunteers in communicating with, understanding and encouraging the elders in the service process. Involving them did significantly enhance the service effectiveness and acceptability intended of the project. For the local community, a network system of neighbourhood volunteer support has also emerged.

 

 

Fostering a train-the trainer program to improve regular exercise behavior in patients with diabetes
13:46 - 13:55
Presented by : Dr. Jo Jo KWAN (DM)

Introduction

Research evidence consistently supports the benefits of exercise in people living with diabetes. In addition, regular exercise is crucial for enhancing overall sense of well-being, which eventually can help to improve many other health conditions. However, patients may find it difficult to initiate exercise activity and persevere the habit. Therefore, a train-the trainer exercise program was promulgated in our Hospital to facilitate patients to establish exercise behavior and perform safe and appropriate exercise practice.

Objectives

The program aimed to equip Diabetes Exercise Dance Ambassadors through a train-the trainer program. On the other hand, the trained ambassadors conducted Diabetes Exercise Dance classes under staff supervision. As a result, both ambassadors and patients could enjoy the benefit and fun of exercising together.

Methodology

A structured exercise training program was managed by multi-disciplinary professionals. Before the exercise class, participants would be educated on practical issues related to diabetes and exercise, such as preventive measures, calorie counting and proper foot wear. In addition to knowledge delivery, the exercise ambassadors were also empowered to be the leader of running the exercise dance. A Diabetes Chair Dance DVD incorporated meaningful lyrics and delightful melody was employed to guide the training on dancing steps and movements. Pre and 6-week post exercise behavior and knowledge were evaluated.

Results & Outcome

A total of 9 Diabetes Dance Ambassadors (Female = 7, mean age 60 year) and 61 diabetes patients (Female = 42, mean age 66 year) were trained. Post evaluation showed that exercise knowledge was significantly improved by 50%. It was encouraging to notice that 62% of the attendees could maintain at least 150 minutes of moderate intensity exercise per week. After the program, the participants mentioned they found it easier and were more keen to perform regular exercise. In conclusion, through this innovative approach, a structured Diabetes Exercise Program was successfully launched to encourage patients with diabetes to have regular exercise behavior. Long term benefit on metabolic control should be monitored and continuing evaluation to assess the sustaining effect is also essential. We would like to give special acknowledgement to Hospital Authority Charitable Foundation for funding support of this program.

 

 

Patient and Nurse Empowerment Program to Strengthen the Discharge Information and Communication
13:56 - 14:05
Presented by : Connie LEUNG

Introduction

Empowering patient on knowledge of self-care after discharge is crucial for patient safety and health. HAHO Patient Experience and Satisfaction Survey on Inpatient Service (PESS) 2015 showed area of improvement on provision of “Information on Leaving Hospital” in PYNEH.

Objectives

1. To empower patient knowledge and enhance patient satisfaction on discharge information. 2.To empower and facilitate nurses in providing concrete and written discharge information to patient.

Methodology

Working Group on Pre-discharge Patient Empowerment Program (PPEP) designed a discharge information toolkit with department specific information leaflets. These toolkits were given by nurses when patient upon discharge; they included instructions and side effects of common medications, the danger signals and recovery information; and the ward contacts. A “Discharge Medication Gentle Reminder” Label was stuck on Patient’s Copy to alert and educate patient for any changes of medication regime. All of them were packed in a specially designed zip bag to patient. After implementation of the program, a “Patient Telephone Survey” was conducted to discharged patients by trained hospital volunteers to solicit feedback and explore any improvement area from patients. Meanwhile, a “Nurse Satisfaction Survey” was conducted to get opinion from nurses.

Results & Outcome

From Apr to Aug 2018, 72.4% (239/330) of target patients completed the “Patient Telephone Survey”. Compared with the PESS in 2015, there was an overall improvement on provision of “Information on Leaving Hospital”. The average scores of four items ranged from 6.3 to 9.2 (0 - No; 5 - Yes, to some extent; 10 – Yes, completely or definitely). From Feb to May 2018, 79% (68/86) of nurses completed the “Nurses Satisfaction Survey”. Nurses agreed with the PPEP would raise patient’s satisfaction and facilitate them in conducting patient education upon discharge; they expressed the workload was acceptable and they supported the PPEP for continuous promotion. With the assistance of discharge information kit, nurses only spent average 4.6 minutes more on patient education upon discharge after implementation of this program. Conclusion: The PPEP was effective in strengthening the discharge information support to patient and facilitating nurses to provide concrete and written information to patient on discharge. The mutual communication and appreciations were achieved.

 

 

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