(Dr Koi Man, Cheng) (Consultant)

(Castle Peak Hospital) (HA convention 2017)

(16 May 2017)

Telemedicine consultation in Castle Peak Hospital (CPH) for stable psychiatric

outpatients in custody

SECTION 1

INTRODUCTION

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To address the above problems, this study

Aims at

Assessing the benefits of using telemedicine consultation for a group of stable psychiatric outpatients in custody

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In the US, a demonstration of utilizing telemedicine in prison in 1996 concluded that this practice is cost effective Effective substitutes for direct, in-

person consultations in specialties like psychiatry

A decline in violence incidents

U.S. Department of Justice. Telemedicine can Reduce Correctional

Health Care Costs: An Evaluation of a Prison Telemedicine Network. 1999.

Telepsychiatry • Psychiatric consultation and short-term follow-up can be as effective when delivered by telepsychiatry

as when provided face to face (Richard O’Reilly et al. Psychiatric Services 58; 2007)

• In a systemic review of telepsychiatry (Salmoiraghi et al. J Psychiatr Pract 21 (5); 2015), the findings are:

1. High patient satisfaction with positive attitude 2. Correlated with decreased admissions 3. Similar quality of clinical interaction to that of face-to-face care 4. Cost effective

• Telemedicine may be a useful alternative to face-to-face clinical visits for management of dementia patients in rural areas (Heeseok Kim et al. J Telemedicine & Telecare 23; 2017)

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In Hong Kong, the use of

telemedicine in psychiatry is not

new

Videoconferencing was found to be feasible, acceptable to staff and patients and cost-effective WK Tang et al, Telepsychiatry in psychogeriatric service: a pilot

study; Int. J. Geriatr. Psychiatry 16 (2001)

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Opportunity CSD proposed to HA a pilot project ~ 2012

clinically stable psychiatric outpatients who are in the custody of CSD can choose to participate in real time and interactive telemedicine psychiatric consultation Pilot sites: Castle Peak Hospital (CPH) of HA and Lai Chi Kok Reception Centre (LCKRC) of CSD

embarrassment and stigmatisation can be avoided

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Deliberation

Telemedicine Liaison TG (CPH & CSD)

Jun 2012

Conducted survey in SOPC, CPH

July 12 – Jan 13

Performed demonstration at SOPC, CPH

Jan 2013

Consultation in COC(Psy)

30 Apr 2013

Meeting with Legal Section & Technology Management Section

12 Sept 2013 Presentation in HA Committee on Innovative Technology & Application

4 Oct 2013 Further advice from CISPO on the proposal was sought

Oct – Nov 2013 To present in SMM Submission to NTWC CREC

Jan 2014

SECTION 2

Methodology

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Hypotheses

Inclusion criteria • Male outpatients in custody of CSD

attending follow-up at CPH • Aged between 21-64 • In stable psychiatric condition

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Methodology

Exclusion criteria • prominent and recent change/deterioration in mental

condition

• regular blood tests needed

• drug administration in SOPC required

• new to psychiatry service

• visual or auditory deficits, which may impair the ability to interact via videoconferencing

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Methodology

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Methodology

1 Jun 2014 to 31 May 2016

Period:

age-matched outpatients fulfilling the inclusion and

exclusion criteria attending face-to-face consultation at

other psychiatric SOPCs

Matching:

4 (face to face interview required for the fifth

consultation)

Maximum telemedicine attendance:

Written consent

SECTION 3

Measurements

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Measurements Demographics

Standard of care: 1) Comparison of Pre-post GHQ difference between cases and comparison group for the first attendances- U test 2) Correlation of Pre-Post GHQ between the first and second telemedicine consultation sessions 3) Satisfaction survey

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Measurements

• Satisfaction survey (Nine Likert scale (1-5) questions, total marks range from 9

(best) to 45 (worst)

• Significant adverse events

• Cost analysis

SECTION 4

Results

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Results • Total number of PICs attendance at CPH within the study period = 377

• Number of attendance excluded because of exclusion criteria = 99

• Number of attendance refusal (+/- reasons) = 49

• Other reasons* of not attending telemedicine = 57

• Total telemedicine attendance = 172

• Total number of patients = 86

• Total number of comparison group = 249

* Release from prison before FU (43)

Fifth attendance (7)

Relapsed soon before FU (2)

Others (5)

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Results Case (86) Comparison group (249)

Age Mean SD Mean SD t P 40.35 11.03 40.23 9.24 0.099 0.922

Pre-GHQ 25.51 5.64 25.61 6.33 -0.133 0.894

Education Primary >Secondary Primary >Secondary 23 66 53 196

Primary Dx N % N % SA 45 52.3 129 51.8

schizo 24 27.9 39 15.7

affective 5 5.8 18 7.2

others 12 14.0 63 25.3

Types of offence • Category A (N=2)

• Sentence > 12years • Need stronger strength of escort • E.g. murder, manslaughter, trafficking of D.D.

• Non-Category A (N=84) • Sentence < 12years • E.g. Theft, Robbery, Common Assault

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Pre-Post GHQ Case Comparison

group z p

N 86 249

median 3 2 -2.268 0.023

Interquartile range 6 4

Correlation between 1st and 2nd teleconsultations

N = 29 r p

0.406 0.029

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Satisfaction survey Case

N 86

Mean score 16.48

SD 4.35

One comment of slow connection

Duration of on air time

N 86

Mean (min) 6.33

SD (min) 3.58

Median/Mode (min) 5

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Save $1850 escort cost

No significant adverse events

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Discussion • A significant proportion of PIC can be benefited from the service, which is

safe and sustainable

• comparable to face-to-face interview in suitable patients

• Preferred by patients

• ↓ cost + ↑public safety

• No significant adverse events

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Limitations • Lacks clinical outcome measures

• Small sample size

• Limited to stable, follow-up patients

• Male patients only

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Set up more stations in CSD

Way forward

Recruit female patients Expand to other SOPCs

Acknowledgement All participating patients Names not listed in order

Mr CW Yeung

Mr Culex Tse

Dr NM Kwong

Mr CM Ho

Ms Sylvia Choy

Mr MH So

Mr KW Chung

Mr ST Wong

Ms Cherie Au Yeung

Dr Bonnie Siu

Dr CK Tung

Dr CF Tsui

Mr Kenny Wong

All participating staff of CPH and CSD

THANK YOU!

Workflow Workflow of Telemedicine Consultation Study for Stable Psychiatric PICs in CPH (29.4.2014) for case group.pdf

Workflow of Telemedicine Consultation Study for Stable Psychiatric PICs in HA Psychiatric Centre (29.4.2014) for control group.pdf

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