Authors (including presenting author) :
Chen XR Catherine (1), Cheung CY (2), Au Yeung YT (2), Fong WC (2) and Li YC (1).
Affiliation :
1.Dept. of Family Medicine and Primary Health Care, Kowloon Central Cluster (KCC), Hospital Authority (HA) 2.Dept. of Medicine, Queen Elizabeth Hospital (QEH), KCC, HA
Introduction :
About 30-40% of referrals to Medical Specialist Outpatient Clinics (SOPCs) of QEH are from 5 QEH based GOPCs. To facilitate primary care and secondary care interface and to shorten QEH Medical SOPD new case waiting time, FM-MED joint clinic (FMJC) session co-operated by QEH MED team and KCC FM team was set up since 10/2022.
Objectives :
This study tried to review the service efficiency of this joint clinic model and to work out improvement strategies.
Methodology :
Study design: Cross sectional service review of FMJC at Yau Ma Tei Jockey Club Clinic (YMTJCC) of KCC. Subjects: Patients who have attended the FMJC from 1 Oct, 2022 to 30 Sept, 2023 were included in the data analysis. All cases referred to QEH MED SOPD from the 5 QEH based GOPCs will be firstly be screened by clinic doctor in-charge of GOPCs, and triaged to either FM Specialist Clinic (FMSC) or MED SOPD of QEH by pre-defined triage protocol. Those cases referred to MED SOPD will be attended at FMJC by senior doctors of both teams in parallel session. Outcome: The reasons of referral, attendance and discharge status were reviewed and the improvement strategies were explored.
Result & Outcome :
Totally 202 cases have attended FMJC during the study period. Among them, 127 (62.9%) are female and the average age is 65.1±14.0 years old. Concerning the reasons of referrals, the top 3 subspecialties are Cardiology (27%), Endocrinology (23%) and Rheumatology (20%). After one year FU at FMJC, 108 cases (53.5%) were successfully closed and among them, only 16 cases (14.8%) were referred back to MED subspecialty team for further management, and 92 (85.2%) cases were either case closed without further FU or to have continued care in GOPC. Among those who were closed to FU at FMJC, most of them were attended either once or twice (n=95, 88%) before the discharge. To facilitate the timely investigation and treatment, some new choice of investigation such as the overnight dexamethasone suppression test and special drugs such as third line Helicobacter Pylori treatment etc. had been introduced to FMSC. To enhance the knowledge and skill transfer between the two teams, a series of educational talks by MED specialists were delivered at Dept. educational meeting. The KCC FMSC management guideline was updated with some conditions previously referred to MED SOPD are now being triaged to have assessment at FMSC. Conclusion: The FM-MED Joint clinic model is proved to be highly effective with very low referral back rate (<15%) and fewer attendance before case closure (88% needing ≤ 2 attendance). The primary and secondary care interface, mutual referral pathway, knowledge and skill transfer between the two teams had been greatly strengthened via this win-win approach. This model helps to provide timely and comprehensive care for patients in need of specialist care and significantly reduced the MED SOPC referrals to QEH and KCC as a whole.
