Authors (including presenting author) :
Cheung YM(1), Cheung L(2), Leung AL(1), Cheng KH (2), Li KK(2), Li W(2)
Affiliation :
(1) Ambulatory Care Centre QEH, (2) Department of Orthopaedics and Traumatology QEH
Introduction :
Musculoskeletal pain conditions are very common in Hong Kong, affecting all ages, especially in back & neck pain, and has created a rather large patient loads to Orthopaedics and Traumatology Outpatient Clinics. The burden is predicted to increase dramatically unless action is taken on time. Especially the repeated subsequent follow-up, those are the mainly burden affect the existing situation. Patients with back & neck pain often worried of delaying seeing a doctor specialized in this condition. Actually, some require specialty level of care and some do not. Appropriate follow-up arrangement and self-empower program are required to manage the population concerns timely.
Objectives :
(1) To shorten waiting time for subsequent follow-up in specialist clinic
(2) To triage to appropriate treatment group
(3) To empower patient in musculoskeletal self-empower management
(4) To control the number of subsequent cases accumulate.
(5) To facilitate reshuffle the manpower and resources to cater the new cases.
Methodology :
The control group (Oct 2019 to Dec 2019, n= 299 ) is patients attending spine clinic. The intervention group (Oct 2019 to Dec 2019. n=62 ) is patients attending Integrated Spine clinic (ISC). Outcome measures were: (1) Waiting time for first subsequent follow-up appointment, (2) Number of patients taken over by Spine Clinic, referred to Family Medicine, and discharged from clinic. (3) Number of patients with spine surgery booked.
Result & Outcome :
As expected, the waiting time for first subsequent follow-up appointment was shorter in intervention group (47 weeks versus 8 weeks). Until now, only two complex cases requiring specialty level of care were taken over by Spine Clinic. Non-indicated patients were diverted to General Out-Patient Clinic for appropriate level of care (n=2). Majority of patients were empowered for self-management programme including lifestyle modification. Over 80 % of the patients attending Integrated Spine Clinic demonstrated improvement in the Numeric Pain Rating Scale (NPRS) and Activities of Daily Living(P< 0.05). In addition, patients also scored substantially higher on all SF-12 subscales including both Physical Component Scores and Mental Component Scores (P< 0.05). With integrated clinic, self-awareness of what can be achieved for musculoskeletal conditions by lifestyle interventions, pharmaceutical treatments, surgery and rehabilitation was effectively enhanced. High risk or with early features of musculoskeletal conditions were timely identified. Caseload has been efficiently managed via integrated coordinated multidisciplinary care focused around the needs of the individuals. It can control the number of subsequent cases accumulate and also facilitate reshuffle the manpower and resources to cater the new cases.
