Authors (including presenting author) :
Siu PY(1), Yung YY(1), Wong TK(1), Yau LM(1), Chan PF(1), Mok PH(2), Cheung YN(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, UCH
Introduction :
The UCH FMSC provided care to type 2 (T2) diabetes mellitus (DM) patients downloaded from UCH General Medical Clinic (GMC). These patients carried significant degree of DM complexity or co-morbidities which might not be easily managed in General Out-patient Clinics (GOPC). 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 Diabetes Ambulatory Care Centre (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 fast track bi-directional patient exchange programme 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 31th Jan 2019 were analysed.
Result & Outcome :
There were 66 and 65 first attendances at DACC and FMSC respectively. Duration of DM was significantly longer for patients referred to DACC (mean 20.5 years) compared to those referred to FMSC (mean 7.9 years, p< 0.001). Mean waiting time for first appointment was 14.3 weeks to DACC and 17 weeks to FMSC. Glycemic control significantly improved after referral to DACC with mean HbA1c dropped from 9.7% to 8.6% (p< 0.001) over an average of 3.5 consultations. On the other hand, blood pressure (BP) improved significantly after referral to FMSC. Mean systolic BP improved from 138 to 129 mmHg and diastolic BP from 79 to 76 mmHg (p< 0.05) after an average of 4.4 consultations, possibly due to the opportunity for more frequent drug titration. Conclusions: This fast-track patient exchange programme provided a platform for timely and better-matched level of care for T2DM patients in DACC and FMSC. Improvement in metabolic control was shown in both groups of patients. Collaboration between family physicians and diabetologists contributed to an efficient interface between primary and secondary care.
