Authors (including presenting author) :
LEUNG GTK (1); WONG KY(3); LEUNG VMC(1); LIN W(1); YIP LS(1); TUNG SM(2)(3); CHANG CH(3); WONG MTP(3); WOO OKL(2); YUE LWL(3); LI SM(1); CHEUK CKL(1); CHOI RYY(3); NG JMK(1)(2)(3); TONG KY(1), TAM KW(2)(3)
Affiliation :
(1) Common Mental Disorders Clinics, Prince of Wales Hospital, (2) Common Mental Disorders Clinics, Alice Ho Miu Ling Nethersole Hospital, (3) Common Mental Disorders Clinics, North District Hospital
Introduction :
1. To reduce out-patient waiting time for routine cases, 2. To provide time-limited, structured and multidisciplinary team support, by need-based, personalized and trans-diagnostic approach, from psychiatrists, psychiatric nurses, occupational therapists and/ or clinical psychologists for patients aged 16 or above with common mental disorders.
Objectives :
The clinic in-charge psychiatrists screen the referral letters and triage forms and recruit suitable routine case patients based on the following exclusion criteria: 1. Patients with psychotic symptoms 2. Patients with active suicide idea 3. Patients with on-going alcohol/ substance misuse 4. Patients with mental retardation 5. Patients with marked cognitive impairment 6. Patients with on-going medico-legal issues Patients would then receive multidisciplinary assessment by psychiatrist, occupational therapist and nurse at the first visit. Management plan would be formulated by the three disciplines and intervention by the team would be implemented according to patients’ needs and wish. Progress and outcome will be evaluated in multidisciplinary discussion and by standard tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7– item (GAD -7) Scale and Insomnia Severity Index (ISI). The treatment period by the team is usually around 9 months.
Methodology :
From July 2017 to October 2019, NTEC CMDC has provided 1974 new case consultations (1102 in PWH, 512 in NDH, 360 in AHNH). The 90th percentile waiting time of general adult routine cases in NTEC has been successfully reduced from 99 weeks in 3Q16 to 60 weeks in 2Q19 (50 weeks in PWH, 77 weeks in AHNH and 58 weeks in NDH) . While for the psychogeriatric counterpart, it was reduced from 192 weeks in 3Q16 to 83 weeks in 2Q19 (56 weeks in PWH, 86 weeks in AHNH and 81.4 weeks in NDH). There were 1183 patients discharged from our CMDC service during the period from July 2017 to October 2019, with a discharge rate of 59.9%. Among the 1183 discharged patients, 734 of them (62.0%) need no further active follow-ups at our psychiatric clinics. The main categories of diagnoses were anxiety spectrum disorders (487%), , Non-organic sleep disorder (11%), depressive episode (11%) and others (7, and others (8%) . There were 23% of cases without any formal psychiatric diagnoses after first multidisciplinary assessments. The average of PHQ9 score was reduced from 9.81 before treatment to 4.43 after treatment; for GAD-7, from 8.95 to 3.86; for ISI, from 13.07 to 6.77. These all reflected significant symptom improvement with our intervention. Conclusion CMDC has successfully shortened the waiting time in both adult and psychogeriatric out-patients in the routine case category, and is shown to have a satisfactory outcome in terms of symptom improvement and discharge rate.
Result & Outcome :
I DISAGREE to send the abstract to Continuous Quality Improvement Initiatives System (CQIs) for sharing after HA Convention.
