An Elder Friendly Environment - Bridging the Gaps in Service Provision Dr H Fung Oct 2008.

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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2007

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