Authors (including presenting author) :
Lau WLC(1), Chan YL(1), Tsui TS(1), Ko WN(1), Lam WT(1), YIP KHC (1), CHAU HY (1), MAN YC (1), LEE CH (2), HO SWS (3)
Affiliation :
(1) Occupational Therapy Department, Kowloon Hospital
(2) Occupational Therapy Department, Wong Tai Sin Hospital
(3) Occupational Therapy Department, Queen Elizabeth Hospital
Introduction :
During the 5th wave of COVID-19 pandemic, local in-patient COVID-19 service framework and post discharge case management approach by occupational therapist (OT) were adopted to enhance our services quality according to the needs of COVID-19 patients.
Objectives :
1. Review the outcomes of COVID-19 rehab service framework during in-patient
phase
2. Explore the impact of long COVID symptoms on the discharged COVID-19
patients and future service direction according to their needs in community
phase
3. Evaluate the effectiveness of case management approach by OT under
integrated care and discharge support (ICDS)
Methodology :
A total of 1054 COVID-19 patients were referred to OT in-patient service from March to April 2022 in KH. 824 subjects were finally recruited for data analysis. Their demographic characteristics, discharge destination, OT interventions, functional outcomes, mortality & readmission rate were explored. Total 22 patients recovered from COVID-19 under OT case management in ICDS from March to May 2022 were recruited for review. The impact of long COVID symptoms, functional outcomes and readmission rate were assessed.
Result & Outcome :
For in-patient phase, OT service coverage for COVID-19 patients was over 80% in KH. 33% were old aged home (OAH) cases, 56% were home cases with caregiver and 11% were home alone cases. The top 3 comorbidities of the COVID-19 in-patients were respiratory disease (32%), cardiac disease (12%) and neurological disease (12%). The mortality rate of OAH cases were 3.5 times higher than home cases. The median length of stay was 15 and 20 days for OAH and home cases respectively. The top 3 focuses of OT interventions for COVID-19 in-patients were ADL, cognitive and discharge planning. Modified Barthel Index (MBI) and Montreal Cognitive Assessment Hong Kong version (HK-MoCA), as outcome measures indicated improvement in their self-care and cognitive functions upon discharge especially for the home cases. The recruited COVID-19 in-patient data were retrieved by CDARS to trace on their readmission rate of the first 28 days after discharge. The overall readmission rate was 22.7% and the major reason of readmission was due to respiratory condition (47%). Further enhancement of OT service framework to triage and guide for OT intervention for COVID-19 patients were urged. Besides, the results indicated the needs for post-discharge support service to sustain their healthy community living in order to prevent avoidable re-admission.
For community phase, a self-developed screening tool for long COVID symptoms and their impacts on six functional domains was used to facilitate individualized intervention. Total 22 patients recovered from COVID-19 were under the care by case manager of OT in ICDS after discharged. Their top 4 common long COVID symptoms were fatigue (52%), dyspnea (33%), decline in cognition (33%) and mood disturbance (29%). Around 50% of the recruited patients suffered from different level of impact on their 6 functional domains included ADL, IADL, leisure, cognitive function, mood problem and life role. Their pre and post functional outcomes in ICDS such as MBI and Functional Independence Measures (FIM) showed significant improvement. Furthermore, there was no readmission in the first 28 days after discharged from ICDS. Further development of COVID-19 specific intervention package such as functional restoration program, cognitive training program, coping strategies program and well- being program should be addressed.
Based on our preliminary COVID-19 service review during the in-patient and the community phase, the data provided direction and insight for our service development to strengthen our support to clinical team in the next rebound of the COVID-19 pandemic.
