an elder friendly environment - bridging the gaps in service provision dr h fung oct 2008
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An Elder Friendly Environment- Bridging the Gaps in Service Provision
Dr H FungOct 2008
Elderly Service Providers in HK
• Hospital Authority• Department of Health• Social Welfare Department• Non-Government Organizations• Private sector
Declaration of Alma-Ata 1978 World Health Organization
Health, which is a state of complete physical, mental [psychological] and social wellbeing, and not merely the absence of disease or infirmity
Health Needs of Elderly
PhysicalPsychological
Social
Biopsychosocial Model(Engel, 1980)Textbook of Family Medicine, McWhinney
Networking with the various providers
Best Outcome
Population Statistics in NTEC, 2007
167,452
13%129,949
10%
964,220
77%
00-14 15-64 65+
Total population in NTEC: 1,261,621
NTEC Elderly Population
• 130,000 >65yrs old
Entire NTEC
NTEC service utilization 2007
26-29%elderly
GOPCpopulation
SOPCpopulation
29%elderly
40%elderly25%
elderly
AED population
IP/DPpopulation
NTEC Service Coverage• 130,000 >65yrs
old
GOPC
Entire NTEC
SOPC
AED
IP/DP
106,502 (82%)
Utilization of Services(Elderly: 130,000)
• HA patients: 106,502 (82%)
• GOPC: 57,108 (44%)
• SOPC: 71,625 (55%)
• AED: 46,857 (36%)
• IP/DP: 32,145 (25%)
Overlapping of Services(Elderly: 130,000)
• GOPC+SOPC: 29,565 (~52% of GOPC patients also attend SOPC)
• GOPC+AED: 20,745 (~40% of GOPC patients also attend AED)
• SOPC+AED: 30,498 (~40% of SOPC patients also attend AED)
• GOPC+Adm: 13,315 (~20% of GOPC patients need admission)
• SOPC+Adm: 25,783 (~36% of SOPC patients need admission)
• GOPC+SOPC+AED+IP/DP: 9,220
Proposition 1 : Our gaps in services lie in the overlaps
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Reasons for GOPC Attendance
GOPC patients attending AED & Admission after AED
13087
6827
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15223
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Region and Year
Total population
AED attend no
Admission no
GOPC patients: Reasons for AED Attendance
URTI
Gastroenteritis
Abdominal pain
Low back pain
Dizziness
Chest pain
GOPC patients: Reasons for AED Admission
Fever
Chest painDecreased GC
Dizziness
COPD
Abdominalpain
Proposition 2 : Primary care problems are inadequately addressed
IP/DP, AED, SOPD Services NTEC, 2007
All ages episodes
65+ episodes
65+ headcount
s
65+ episodes/ headcounts
IP/DP195,043
(100%)77,422
(40%)32,145 2.4
AED390,490
(100%)96,660
(25%)46,857 2.1
SOPD922,451
(100%)265,709
(29%)71,625 3.7
Top 10 diagnoses of geriatric patients with hospital admission, NTEC, 2007
No. of IP/DP episodes
No. of IP/DP headcounts
Ratio of episodes/ headcount
% of total IP/DP episodes(>
65y.o)
Malignant neoplasm 6020 2663 2.3 8%
COPD 4753 2007 2.4 6%
CRF 4725 475 9.9 6%
Pneumonia 4436 3174 1.4 6%
Heart failure 2294 1365 1.7 3%
IHD 1708 1232 1.4 2%
Fracture hip 1436 919 1.6 2%
DM 1271 1145 1.1 2%
Gall bladder disease 945 655 1.4 1%
CVA 554 395 1.4 1%
Community Care ServicesNTEC, 2007
No. of CNS visits for 65+ aged 86,160
No. of geriatric outreach attendances
71,133
No. of geriatric day attendances 24,771
No of Visiting Medical Officer attendances
21,999
No. of Psychogeriatric outreach attendances 7,971
Bridging the Gaps: Existing Model
• Support to OAH and elderly centres:• GOPC reserved quota• Phone consultation• Video consultation• After hour’s home visit• VMOs
Caring in the community
Proposition 3 : Scope of community support is too limited to be effective
Bridging the Gaps:
Re-thinking Primary Care
Primary care is not for gate-keeping. It’s for HEALTH!
Public Hospital System
Nurse
AH
Volunteer
Home
GP
NGO
Health Resource Centre
Telephone Hotline, E Health, Consumer Health
Doctor
Enriching Primary Care
Patient Flow
Primary and Community Health Centre
Primary Care Out-patient Section
• Step-down clinic• Family Medicine triage clinic• Day treatment• Community outreaching services team • Community assessment service• Allied health clinic services• Nurse-led clinic services• Training facilities
Primary and Community Health Centre
Community Health Section
• Day rehabilitation services• Day psychiatry rehabilitation services• Health resources centre
• information enquiry, telephone hotline, nursing consultation, social service support, health promotion programmes, rehabilitation shop, physical fitness and recreation
• NGO hub
• Mental health promotion
• Different from existing HA Day Hospital Services
A Centre for HealthNavigation!
Bridging the Gaps:
Engaging the Private Sector
NTE Primary Care Coordinating Committee (PCCC) 2007
Objectives
• to promote population health in NTEC• to enhance the role of primary care in
the overall management of patients• to enhance collaboration between pri
vate doctors and public hospitals for the continuity and improvement of patients management and care
• to launch health promotion programmes and promote healthy behaviour and lifestyle of the public
Membership
Advisors: Dr. FUNG Hong
Dr. CHOW Chung Kwan
Co-Chairmen: Prof. Philip LI
Dr. Kelvin Siu Wan WU
Members: Dr. Nancy TUNG (Rep. from NTEC and Hospitals)
Dr. Augustine LAM (Rep. from NTEC and Hospitals)
Dr. MAK Wing Kin (Rep. from HKMA Shatin Community Network)
Dr. CHIU Sik Ho (Rep. from HKMA Taipo Community Network)
Dr. LEE Chok Huen (Rep. from HKMA Taipo Community Network)
Dr. CHAN Kin Hing (Rep. from HKMA Taipo Community Network)
Dr. LI Shan HO (Rep. from HKMA Taipo Community Network)
Dr. Thomas SZ (Rep. from GPs in North District)
Sponsors: NTEC
HKMA Taipo Community Network
Working Groups
• Referrals• IT and Communication• PPI Projects
Programmes on Referrals
1. Triage Guideline for Medical Cases2. HKMA District Based Doctor Lists3. Promotion of Family Doctors through
Appointment Slips4. Setting Up Information Centre at SOPC
of AHNH
PPI Projects
1. Promotion of PPIS – Shared DM Care Programme
2. Yao Chung Kit DM assessment centre3. ePR enrolment
Programmes on IT and Communication
1. Website/Newsletter2. GP information Booklets to Schools3. GP information Posters at GOPCs, SOPCs, AE
Ds
Local Initiatives:
1. Urology: training for GPs, donation of silicone foleys
2. Substance abuse among adolescents3. One School One GP4. Mental health liaison
Bridging the Gaps:
Creating Choice
NTEC PCCC Website
“NTE Health Choices”
a. Open fieldb. Restricted field
NTE Health Choices (Open Field)
NTE Health Choices – GP List
GP List links to HKMA Doctors Homepage
Caring for Yourself
NGO & Patient Group Link
Dr. Members Zone
(Restricted Field)
Conclusion
• Enlarging the caring community• Enriching diversity of services• Engaging everybody• Empowering the elders
Creating an elderCreating an elderfriendly environmentfriendly environment