Authors (including presenting author) :
Chan F(1), Tai WK(2), Wong WT(2), Ip CK(1), Lam CK(3), Fung ML(3), Chu SY(1), Sheung, WH(1), Pang YT(1), Mo YM(1)(2), Lo CF(2), Ng CF(1), Louie TMF(3)
Affiliation :
(1)Department of Psychiatry, North District Hospital, (2)Department of Psychiatry, Tai Po Hospital, (3)Department of Occupational Therapy, Alice Ho Miu Ling Nethersole Hospital
Introduction :
Dual diagnosis, refers to concomitance of substance-use disorder and any type of psychiatric disorder, increases burden towards health care system. The proportion of reason of admission due to dual diagnosis increased from 15% to around 25% in recent 10 years in Department of Psychiatry, Tai Po Hospital. The unplanned readmission, default rate in SOPD and violence propensity are 2.5-times. 2.15-times and 3.5-times higher than other psychiatric illness, respectively. To tackle this challenging situation, a pilot program incorporated integrated model has been implemented since Jul, 2020. A specialized team comprised of psychiatrists, psychiatric nurses, occupational therapists, social worker, peer specialist and community partners has been formed without additional resources. Dual-diagnosed patients will be directly admitted or referred from general adult teams for specialized service in inpatient settings according to the residential address, patients’ needs and complexity of care. Intensive and collaborative work has been provided by that specialized team then from inpatient to outpatient as transitional care for dual-diagnosed patients.
Objectives :
1. To provide evidence on the effectiveness and feasibility of the implementation of integrated program
2. To suggest for the possible modification in the future implementation
Methodology :
A preliminary review has been provided to analyze the yearly admissions, rate of unplanned readmissions and yearly default rate before and after index admission in the period of 7-10/2020. Qualitative feedback has also been collected from patients and their carers for service improvement.
Result & Outcome :
62 patients have been recruited for service evaluation which was around 40% of the total number of dual-diagnosed patients in inpatient settings. Promising improvement on the three outcomes were noted as reduction of yearly admission from 51 admissions/year to 6 admissions/year (improve 88%), drop of unplanned readmission from 33.3% to 0% (improve 100%) as well as drop of default rate in SOPD from 40.6% to 14.3% (improve 65%). Participants and their carers appreciated on the transition care with more tailor-made work on their challenges. Extra manpower and resources are necessary for full implementation of the program.
