Authors (including presenting author) :
Ding Q(1), Ho WY(1), Young CH(2), Leung YP(2), Kwok KY(1), Ip CY(1), Ho WS(1), Tsoh MY(2), Hui E(1)
Affiliation :
(1)Division of Geriatrics, Department of Medicine and Therapeutics, Prince of Wales Hospital, (2)Psychogeriatric Team, Department of Psychiatry, Prince of Wales Hospital
Introduction :
Specialist out-patient clinic (SOPC) waiting time gradually lengthens over the years due to aging population. Elderlies with dementia are often followed up in both Geriatrics and Psychogeriatric (PGT) SOPC in Prince of Wales Hospital (PWH). Duplication of care service imposes burden to healthcare service and increases stress on patients and caregivers from multiple clinic attendances.
Objectives :
(1)To enhance collaboration between Geriatrics and Psychogeriatric (PGT) SOPC and to streamline unnecessary duplication of follow-ups (FU) for dementia patients; (2)To delineate respective SOPC referral guidelines and follow-up criteria for dementia care; (3)A pilot project to help reduce duplication of manpower and resources in SOPC including consultations and related logistics such as medication dispensing.
Methodology :
Stock-take was performed through Clinical Data Analysis & Reporting System between October 2017 and September 2018. Doctors in both teams followed the pre-defined streamlining criteria where communications were made through consultation notes in Clinical Management System. Some patients were streamlined to either Geriatrics or PGT clinic alone, while other patients who had complex medical problems together with difficult Behavioural and Psychological Symptoms would continue both SOPC FU. Liaison nurses from both teams were involved in patient record searching, family communication and inter-departmental liaison.
Result & Outcome :
The project started from February 2019 and was planned to be completed in 1.5 years. Interim results were collected in September 2019, and 331 cases were identified to have dual FU. 106 patients were excluded from the study and 65 patients were yet to be streamlined. A total of 160 cases have completed the assessments. Among which, only 45% of these patients required dual FU, 21.9% and 33.1% of the patients were streamlined to be followed up in either PGT or Geriatrics SOPC respectively. The patients streamlined to PGT clinic only with stable medical conditions were downloaded to the Government Outpatient Clinics. This study showed that the streamlining project reduced a significant number of patients with dementia having unnecessary dual FU. This may have substantial impact on reducing health care costs, improving effective SOPC service provision and minimising patients and their carers’ burden.
