Proposed Topic (Most preferred): :
Clinical Safety and Quality Service II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
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) :
Lit MPK, Lee KH, Mak FT, Chow PS, Wong YH, Chan YH, Chan WMJ
Affiliation :
Respiratory Division, Department of Medicine, Queen Elizabeth Hospital
Introduction :
• IMSN-COPD services started since 2019 involving 10 hospitals in 6 clusters of HK. It was estimated that 3000 COPD patients with 12000 attendances benefiting from the initiative till year 2022. The services advocate a longitudinal integrated care plan that optimizes the inputs of multidisciplinary team including doctors, nurses and allied health professionals along the clinical pathway in Specialist Out-patient Clinics. During the 5th wave of COVID pandemic outbreak, Tele-Health services was urgently developed in order to decrease risk of disease transmission and AGP prevention during inhaler skill education with returned demonstration as well as to improve access to primary healthcare services.
Objectives :
1. To evaluate the effectiveness and treatment adherence after Telehealth services implementation
2. To identify overall’s acceptance by patients and health-care professionals
Methodology :
The Hospital Authority (HA) mobile application ‘HA Go’ is a one-stop mobile platform to connect patients beyond hospital care and facilitates patient empowerment since 2021. A telehealth element for COPD nurse clinic was formulated and integrated into the existing model of IMSN-COPD in February, 2022. Tele-health assessment includes home respiratory equipment use and compliance monitoring, inspiratory effort for adequate drug delivery assessment and inhaler’s return demonstration. HA Information Technology (IT) department was contacted for arrangement after advice was sought and consensus was gained to align the practices across clusters from Specialty Advisory Group (Respiratory), Coordinating Committee of Medicine and Central Committee on COPD, HA in March, 2022. After endorsement by Taskforce on Telehealth HA, a trial run was performed in May 2022 in order to test the wireless stability of the venue, secure the clinical and administrative operations and barriers solution for the adoption of telemedicine practices
Result & Outcome :
A prospective review for the services was started from 19th June 2022 to 31st Jan 2023 with teleconsultation was provided to 112 COPD patients. The surveys included 4 aspects, comprised 37 evaluative items covering various care components which were important to patients. The categories were 1) Understanding COPD diseases treatment plan 2) Nurse clinic services 3) Tele-Consultation services 4) HA Go software utilization. 110 responses were collected who had attended virtual COPD nurse clinic. The total score in each category is 4 and the mean average scores were 3.8, 3.9, 3.95 and 3.85 respectively. There was an overall positive experience, with 96.5% of respondents rating ≥3.8.
Moreover, no significant improvement differences were found in inhaler skills (78.2% vs. 79.5%) and adherence (77.6% vs 74.2%) between physical and Telehealth attendance. (P<0.05). The new services of Tele-Health in IMSN- COPD was adopted immediately in 5 clusters.
Teleconsultation responses are higher amongst others with most comments on saving travelling time and waiting time in clinic especially for those patients with symptoms of shortness of breath and on Long-term oxygen therapy. 99.5% of healthcare professionals including nurses, executive assistant and patient care assistants reflected user friendly and easy to use.
Conclusion
Telehealth consultation in COPD nurse clinic can lower risk of disease transmission, improve access to primary health care services and eliminate the needs for unnecessary travelling, queuing and waiting.
