Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Carrie TANG(1), Wong WM(1), Chan WY(1), Cheung TY(1)
Affiliation :
Occupational Therapy Department, Tuen Mun Hospital
Introduction :
Patients with respiratory diseases are one of the patient groups with frequent admissions to hospital due to exacerbation of symptoms. Advanced technology (AT) was proven to be effective in COPD management for early discharge to ongoing self-management of stable COPD at home (Ding et al., 2019). Mobile health tools are also evolving for different chronic respiratory diseases (Sleurs et al., 2019). Occupational Therapists (OT) in TMH pioneered a patient empowerment program with the use of advanced technology for patients with respiratory diseases discharged from hospital in Integrated Care Model (ICM) Case Management program.
Objectives :
- To promote patient empowerment on management of respiratory diseases after discharge - To enhance effectiveness of care delivery through remote monitoring with advanced technology
Methodology :
All cases with chronic respiratory disease would be recruited from April to December 2023. The program included 3 components- (1) self-monitoring, (2) self-directed home program and (3) patient educational materials. Wearable technology (i.e. fingertip pulse oximeter) was applied as objective evaluation of disease-related parameters and physiological responses in performing daily activities. Patients were also required to report subjective evaluation of disease control e.g. rate of perceived dyspnea and exertion on the activity log-sheet. Self-monitoring focused not only on disease control, oxygen use (if any) but also lifestyle changes. One to two activities were chosen by patients and coached by OT as self-directed home program. Patients were advised to incorporate the self-management skills they learnt in response to the biofeedback obtained from oximeter in home program. Self-education providing educational videos via HA Go included refresher training on dyspnea management, energy conservation techniques and lifestyle modification. Remote monitoring would be considered for cases who are weaning home oxygen therapy (HOT). Firstly, monitored ADL assessment would be conducted in every on-site home visit to review the dosage of oxygen newly prescribed/ adjusted after admission. Secondly, self-monitoring technique on selected ADL tasks with the use of oximeter would be taught to patients and/or carers. After home visit, patients or carers emailed the activity log-sheet to OT. Follow up phone consultation would be arranged for timely feedback on the dosage of HOT.
Result & Outcome :
A total of 13 cases with chronic respiratory diseases were recruited. Diagnosis included COPD, Bronchiectasis, Suspected CA Lung, Asthma, Pulmonary AVM. All patients or with carer support learnt self-monitoring techniques and performed self-directed home program safely. 85% of patients or carers completed the activity log-sheet. 38% patients resumed outdoor activities (> 45 minutes) while 31% patients participated in 15-45 minutes’ home program. 31% of patients with more severe SOB participated ADL training as tolerated or < 15 mins home program. Despite the daily fluctuation of symptoms, all patients were confident in managing their symptoms. Their average self-reported ratings of self-efficacy improved from 4.5 to 6.1 out of 10 after the Self-Empowerment Program. Three patients weaned down HOT with the use of remote monitoring. For prescription of HA Go Tele-info and Tele-rehabilitation, all patients with smartphone (38% of all patients) were prescribed with HA Go Tele-info and Tele-rehabilitation. The compliance ranged from 13% to 86% (mean: 30%). The large discrepancy could be explained by the barriers of elderly in using technology (E.g. forgot password, reluctance to technology and vision problem). Carer support could facilitate the use of HA Go. To conclude, the patient empowerment program engaged patients as active partners in the management of their diseases. Remote monitoring could provide timely support for patients who were weaning down oxygen therapy via phone consultation in addition to regular on-site home visit.
