Authors (including presenting author) :
Loong HNC(1),Lui TWD(1),Fong HYC(2),Wong KCK(1),Lam KYJ(1),Lee CHA(1),Lee CHP(2),Tan CBK(2),Woo YC(1)
Affiliation :
(1) Department of Medicine, Queen Mary Hospital (2) Department of Medicine, The University of Hong Kong
Introduction :
The congested waiting area of specialist out-patient clinic (SOPC) is a potential high-risk area for cross infection during the COVID-19 pandemic, in particular during the days with large numbers of local community-acquired cases. The Hospital Authority has provided the service of drug refill since the first wave of the outbreak. Such drug refill services usually require pre-arrangement. However, some patients made such requests upon arrival at SOPC. Hence, we implemented the ‘Quick-channel for Special Drug Refill’ (Quick-SDR) in the thyroid clinic, to facilitate the on-site drug refill request and to decongest the SOPC waiting area in fulfilment of social distancing.
Objectives :
1) To enhance service quality and continuity of care for patients with thyroid disorders during the COVID-19 pandemic 2) To evaluate the effectiveness of Quick-SDR
Methodology :
Quick-SDR was supervised by endocrinologists in Queen Mary Hospital. Patients who requested for drug refill on-site were assessed and interviewed by a specialty nurse, according to a pre-defined protocol. These patients were educated by the trained specialty nurse regarding self-management of thyroid disorders including symptom awareness for early identification of disease complications, and ensuring drug compliance. Their latest clinical progress and investigation results were reviewed. Patients with stable thyroid function without recent hospitalization or changes in thyroid treatment in the preceding six months were eligible for Quick-SDR after endorsement by the clinic’s physician-in-charge. Patients deemed not suitable would proceed to medical consultations as usual. Patients triaged to Quick-SDR were offered drug refill, with follow-up appointment arranged in 12 to 14 weeks. These patients were also advised to make phone enquiries in case of change in medical conditions before their next scheduled clinic visit. The phone enquiries were reviewed by a physician. Medication adjustment or earlier clinic visit would be arranged if necessary. To study the effectiveness of Quick-SDR, the control group was defined by age- and sex-matched patients with stable thyroid function tests and medical conditions who attended the thyroid clinic in the same period, but did not request for on-site drug refill. The time from clinic attendance to departure from the SOPC, rates of phone enquiries from patients, new onset biochemical hyper- or hypothyroidism, or adjustment of thyroid medications were compared between the study and control groups.
Result & Outcome :
From 4 February to 12 May 2020, 145 patients requested for on-site drug refill. 41 did not fulfil the Quick-SDR inclusion criteria. 104 (71.7%) were recruited to Quick-SDR (mean age was 50±15 years, 76.9% female). In the study group, 63.4%, 3.8% and 32.8% were put on thyroxine replacement, carbimazole, and not on treatment respectively; whilst in the control group, 61.5% 4.8% took thyroxine and carbimazole respectively, and 33.7% were not on treatment. The proportion of the treatment regimens in the two groups was comparable. Most study patients could leave the SOPC earlier within 30 minutes when compared with the control (94.2% vs. 15.3%, p< 0.001). Upon a median follow up of 4.22 months (IQR: 3.08-5.74), we received similar phone enquiries from both groups (study: 1 [0.9%] vs. control 2 [1.9%], p=0.56). Furthermore, there is no difference statistically in changes of thyroid status (study: 1 [0.9%] vs. control: 4 [3.8%], p=0.17) or thyroid medication adjustment (study: 4 [3.8%] vs. control: 11 [10.6%], p=0.06). In conclusion, during the COVID-19 pandemic, special arrangements are made to enhance proper infection control measures. Quick-SDR functions effectively to shorten the length of stay of patients in the SOPC waiting area to minimise the risk of cross infection. Through patient empowerment by a nurse-led education service, it helps to maintain the service quality and enhance continuity of care for patients with thyroid disorders.
