Authors (including presenting author) :
Author: Lam SHC(1), Jim HYB(1), Lo WYI (1), Fung YSE(1), Cheung TYJ (1), Chan WY(2), Cheng SYR(3), Wong WMK(4)
Affiliation :
(1)Occupational Therapy Department, Tuen Mun Hospital; (2) Occupational Therapy Department, Tin Shui Wai Hospital; (3) Department of Family Medicine and Primary Health Care, New Territories West Cluster; (4) Department of Medicine and Geriatrics, Tuen Mun Hospital, New Territories West Cluster;
Introduction :
According to 2017 HA statistics, the prevalence rates of dementia are increasing, 5%-8% among persons aged over 65, and at 20%-30% among those aged over 80. A 2012 study estimated that among persons aged 60 and above, 11% would be suffering from dementia in 2036. The service need for dementia is ever increasing.
3 stages of dementia care were classified to provide OT service in NTWC with reference to the dementia patient journey: 1) MILD-COGNITIVE-IMPAIRMENT (MCI); 2) MILD TO MODERATE; 3) SEVERE. In 2016, OT service was reviewed and restructured based on 3 spectrums: “Patient’s need”, “Waste elimination” and “Create Flow”.
Objectives :
To restructure Dementia OT service in NTWC in a timely, cost-effective and quality ways.
Methodology :
Gap analysis was conducted in 2016, five problems were identified: 1-Same level of care, 2-Treatment limited to Hospital 3-Long waiting time 4-High default rate and 5-High carer stress.
Service enhancement and revamp were conducted along dementia patient’s journey
1) STAGE 1 - Pioneer Cognitive-Assessment-Empowerment-Program
(CAEP) multidisciplinary program in GOPC
2) STAGE 2 - Enhancement in OT services in M&G SOPD
3) STAGE 3 - Enhancement in Community OT (COT) service
Result & Outcome :
From 2016 to 2019, there were about GOPC 400 Suspected-Cognitive-Impaired patients referrals annually. Waiting time of 1st-OT assessment decreased from average 17 weeks to 4 weeks, 5200 weeks are saved after CAEP launched. Complicated patients were selected for CAEP video-case-conference, 55 patients were reviewed in total 20 conferences and triaged to appropriate level of medical and OT services. With establishing the seamless care from GOPC to Geriatric care through CAEP, unnecessary secondary care referral rate was reduced from 60% to 37.5%, 90 patients are well-maintained in community with collaboration of OT and community stakeholder annually.
In SOPD revamp, 16.7% patients were managed in one-stop assessment Geriatric clinic annually. And hence, default rate, lesser journey to OT department and reduction of carer stress was guaranteed.
Finally, COT service was enhanced to support severe dementia patient with BPSD to care at home in order to prevent readmission and improve quality of life.
In CQI process and restructure of dementia management in OTD, the overall effectiveness and efficiency of service delivery, quality of service received by customers was guaranteed and improved. We, NTWC OTD together with our service partners, are endeavoring to explore measures and directions to meet the ever increasing demands.
