Public Private Partnership (PPP) in Community Speech Therapy Service, HKWCView Abstract HA StaffEnhancing Partnership with Patients and Community01:15 PM - 01:25 PM (Asia/Hong_Kong) 2019/05/15 05:15:00 UTC - 2019/05/15 05:25:00 UTC
IntroductionThe 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. ObjectivesThis 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 & OutcomeDescriptive 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 reconstructionView Abstract HA StaffEnhancing Partnership with Patients and Community01:26 PM - 01:35 PM (Asia/Hong_Kong) 2019/05/15 05:26:00 UTC - 2019/05/15 05:35:00 UTC
IntroductionAccording 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.ObjectivesRetrospectively look into pretreatment life style and attitude of patient who had considered immediate breast reconstruction from 2016 to 2018.Methodology99 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 & OutcomeThe 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 homeView Abstract HA StaffEnhancing Partnership with Patients and Community01:36 PM - 01:45 PM (Asia/Hong_Kong) 2019/05/15 05:36:00 UTC - 2019/05/15 05:45:00 UTC
IntroductionFalls 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.ObjectivesTo 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.MethodologyLed 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 & Outcome190 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 diabetesView Abstract HA StaffEnhancing Partnership with Patients and Community01:46 PM - 01:55 PM (Asia/Hong_Kong) 2019/05/15 05:46:00 UTC - 2019/05/15 05:55:00 UTC
IntroductionResearch 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.ObjectivesThe 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.MethodologyA 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 & OutcomeA 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 CommunicationView Abstract HA StaffEnhancing Partnership with Patients and Community01:56 PM - 02:05 PM (Asia/Hong_Kong) 2019/05/15 05:56:00 UTC - 2019/05/15 06:05:00 UTC
IntroductionEmpowering 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.Objectives1. 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. MethodologyWorking 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 & OutcomeFrom 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.
Early intervention to promote Active and Cognitive Stimulating Lifestyle for patients with Mild Cognitive Impairment in the General Out-patient ClinicsView Abstract HA StaffEnhancing Partnership with Patients and Community02:06 PM - 02:15 PM (Asia/Hong_Kong) 2019/05/15 06:06:00 UTC - 2019/05/15 06:15:00 UTC
IntroductionMild Cognitive Impairment (MCI) might not cause significant dysfunction in daily life initially, but might result in cognitive decline without appropriate intervention. There is a service gap in managing patients with MCI in the public primary care settings. The Department of Family Medicine and Primary Healthcare (FM&PHC) in Hong Kong West Cluster (HKWC) identified a service gap after the early detection of MCI and collaborated with the Department of Occupational Therapy (OT) to develop a time-limited OT Elderly Cognitive Care Program (OTECCP) in the general out-patient clinics (GOPCs) since January 2014.ObjectivesOTECCP used an experiential learning approach to help patients and carers to understand the importance of brain health, participation in cognitive stimulating activities and active lifestyle as a potential strategy to delaying cognitive decline in MCI.MethodologyPatients aged 60 or above in GOPCs with Abbreviated Mental Test (AMT) score ≥8 were referred to OTECCP. They were further assessed using The Montreal Cognitive Assessment Hong Kong version (HK-MoCA) and Chinese version of the Activities of Daily Living Questionnaire (ADLQ-CV). Patients with HK-MoCA score≤2 percentile were triaged to receive Specialty OT service for dementia at David Trend Rehabilitation Centre (DTRC). Patients triaged to have MCI were recruited to join the OTECCP, which included 1-4 sessions of cognitive group training and subsequence periodical active lifestyle groups within 1 year.Results & OutcomeOf 788 patients screened from January 2014 to December 2018 (mean age 74.3 years, 60.3% women), the mean scores of AMT, HK-MoCA and ADLQ-CV were 9.1, 20.6 and 13.7 respectively. 10.5%(83) were triaged to receive Specialty OT training at DTRC. 705 patients were recruited to the OTECCP and 222 completed the one-year-follow-up re-assessment. There were significant differences between the mean scores of HK-MoCA(p< .001) and ADLQ-CV(p< .005). HK-MoCA was increased 0.96(95% CI [-1.35, -0.57]) whereas ADLQ-CV was decreased 1.82(95% CI [0.57, 3.08]). The results indicated that cognitive functions have improved and the patients have less subjective memory complaints. Upon completion of the OTECCP starting from Oct 2018, needy patients were referred to Patient Resource Centre of Queen Mary Hospital for bridging to suitable NGO partners for long term support in the community.
A medical-social collaboration project on Anti-stigma of Mental Illness (MI): Enhancing acceptance and help seeking of MI in UniversitiesView Abstract HA StaffEnhancing Partnership with Patients and Community02:16 PM - 02:25 PM (Asia/Hong_Kong) 2019/05/15 06:16:00 UTC - 2019/05/15 06:25:00 UTC
IntroductionRecent studies revealed that seven in ten HK undergraduates showed symptoms of depression and anxiety. The Centre for Suicide Research and Prevention of Hong Kong University analyzed 34 students’ suicidal cases and found that only 20% were receiving mental healthcare before their deaths. This harmful stigmatization associated with MI may reduce students’ motivation for seeking support from mental health service. Stigma defined as a process involving labeling, separation, stereotype awareness and discrimination in a social context . A series of anti-stigma of MI campaign was launched in Yung Fung Shee (YFS) Psychiatric Day Hospital (PDH) since 2017 with collaboration with HK University of Science and Technology (HKUST) Counseling and Wellness Centre, HK Polytechnic University (HKPU) and Tung Wah College (TWC). It included educational programs and collaboration projects of people with MI and University students through different direct contact. Objectives1. Facilitate positive social contact experience between students and people with SMI to enhance acceptance of MI and facilitate help seeking 2. Provide opportunities for people with MI to demonstrate their strength to public in order to reduce self-stigma and encourage social recovery MethodologyTwo nature of programs are carried out: 1. Education: Educational talk was held to explain the facts and myth about MI, useful community resources and the undergraduates could experience the life of a person with MI through a creative board game; 2. Contact: Joint programs were launched to promote contact between people with MI and the undergraduates: a) Lived experience sharing by clients in the three institutes. Clients shared their ways to cope with MI and students had open discussion with them; b) Clients held different tasks group for the students to demonstrate their strength and abilities; c) Students were invited to visit PDH to experience the real life of clients. d) Anti-stigma booth and busking performance were collaborated by people with MI and students in campus during World Mental Health Day.Results & Outcome13 service users and over 80 students from the three institutes joined the scheme. Internalized Stigma of Mental Illness (Cantonese) Scale was used to evaluate the effectiveness of the scheme. Paired Sample T-test showed significant improvement among service users in Question 1 (p=0.007), 4(p=0.021), 5(p=0.013), 10(p=0.007) and total average score (p=0.018). Focused interview was held among the students for qualitative analysis, reflecting improvement in awareness of MI, equality of service users and students, acceptance of MI and more willingness to seek help. To conclude, the medical-social collaboration approach for anti-stigma campaign is an innovative project which not only helped the service users re-integrating into the society, but also reduced discrimination and facilitated help-seeking of students toward mental health support services.