Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
Loong HNC(1), Lui TWD(2), Lee CHA(1), Woo JC(1), Chang YCJ(1) Wong KCK(1), Tan CBK(2), Woo YC(1)
Affiliation :
(1)Department of Medicine, Queen Mary Hospital; (2)Department of Medicine, The University of Hong Kong
Introduction :
Telehealth has become a buzzword during the COVID-19 pandemic. It is defined as delivering health care services at a distance using technology. This includes services delivered to a patient through a virtual visit with real-time interaction. It aims to deliver a more effective health care to patients. Telehealth service has recently been started in the Hospital Authority (HA) for eligible patients via the ‘HA Go TeleHealth’.
Objectives :
1)To enhance service quality and continuity of care for patients with thyroid disorders; 2)To evaluate the effectiveness of telehealth service
Methodology :
Telehealth was implemented in the thyroid clinic at Queen Mary Hospital (QMH) in June 2023 under the supervision of endocrinologists. All patients with stable conditions who did not require physical examination during the consultation were invited to join via ‘HA Go TeleHealth’. Step-by-step instructions were provided in the HA-Go apps. The patients were called by the healthcare staff before their scheduled appointment to explain the logistics of the service, including the use of the ‘HA Medication Delivery Service’, ‘Pay HA’, and ‘MyHealth-My Health Info’. Patients attending the TeleHealth were assessed by a trained specialty nurse according to a pre-defined protocol. Their clinical progress was reviewed, and they were advised to make phone enquiries in case of changes in their medical condition before their next clinic visit. Earlier clinic visits would be arranged, if necessary, after discussion with the physician-in-charge of the clinic. The demographics and clinical characteristics of patients who joined the services were evaluated. To determine the effectiveness of TeleHealth, an age- and sex-matched control group of patients who physically attended the thyroid clinic in the same period was included. All patients in the control group received nurse education after doctors’ consultations. The rates of accident and emergency department (A&E) or hospital admission directly related to thyroid disease, relapse of the disease, and clinic attendance were compared.
Result & Outcome :
From 17 June to 18 November 2023, 31 patients from the thyroid clinic were invited to join ‘HA Go TeleHealth’. All patients have been followed up in the clinic for over two years. In the telehealth group, 35.5%, 1.6%, 4.8%, and 11.3 % of patients were diagnosed with Graves’ disease, multiple nodule goitre (MNG), thyroiditis, and hypothyroidism compared to 32.3%, 6.5%, 1.6%, 12.9% (p=0.76) in the control group respectively. There were more pregnant women in the telehealth group (16.1% vs. 4.8%, p=0.02). All patients were contacted successfully by phone before their appointment and attended the medical consultation via ‘HA Go TeleHealth’ as scheduled. After an observation period of 15±7 weeks, both groups reported no A&E and/or hospital admission related to thyroid disorder, and there were no cases of disease relapse. Intervals of subsequent follow-up were comparable (15±8 vs. 15±8 weeks), and a similar number of phone enquiries were received about the follow-up plan in both groups (3.2% vs. 3.2%). In the telehealth group, 17.7% required physical attendance because of the need for physical examination. All the remaining 82.3% continued follow-up via telehealth as per patients’ wish, and all of them expressed that telehealth was convenient. With appropriate case selection Tele-consultations are safe, convenient, and can efficiently provide care to patients with limited mobility. Such a service delivery model appears to be particularly attractive to pregnant ladies who require frequent monitoring of thyroid status. Healthcare organisations worldwide are expanding the options of telehealth, especially after the COVID-19 pandemic. Continuous technological improvements and further simplifications of processes will enhance the development of telehealth. The service is expected to increase patient adherence and reduce hospital admissions and should be further promoted to patients with chronic diseases.
