Authors (including presenting author) :
Ho PY(1), Chan KC(1), Chan KK(1), Mok WS(1), Ho WS(1), Lai KY(1), Leung CF(1), Lee HS(1), Hui N(1)
Affiliation :
(1)Occupational Therapy Department, United Christian Hospital
Introduction :
Occupational therapy serves a vital role in enhancing patients’ safety and independence through tailored interventions. Specifically, timely advice on home modifications can significantly improve patients' functional status in both basic and instrumental activities of daily living (BADL and IADL). Traditionally, occupational therapists (OTs) conduct on-site home visits as part of community occupational therapy (COT). With advancements in technology, telehealth has emerged as an alternative way of delivering COT services. This innovative approach maintains service effectiveness while reducing the labor intensity compared to conventional method.
Objectives :
The objective of this program is to evaluate the efficiency and effectiveness of telehealth COT services (tele-COT).
Methodology :
In this program, OTs conducted tele-COT sessions with patients and caregivers through the HAGO telehealth platform. The pilot program was carried out from March to October 2024. Patients from UCH medical wards and EMW, who were indicated for home assessment and modification, aids prescription or fall prevention education were eligible for recruitment. Patients and caregivers needed to be able to operate the HAGO APP for arranging tele-COT sessions.
All participants received at least one pre-discharge tele-COT session, with an additional follow-up post-discharge session (either tele or conventional COT) if indicated.
The efficiency of the program was evaluated through assessing the average waiting time and re-admission rate of patients, along with intervention time and manpower usage for OTs when compared with conventional COT. The data for analyzing average waiting time and re-admission rate of conventional COT was extracted from January 2023 to October 2024. The program's effectiveness was further assessed through satisfaction surveys completed by patients, caregivers, and OTs.
Result & Outcome :
A total of 28 cases were recruited, with 20 pre-discharge and 8 post-discharge tele-COT sessions. Among them, 89% (n=25) were from UCH medical wards and 11% (n=3) from EMW. Improvement of efficiency in both patients and OTs aspects were noticed after completion of program.
From the patients' perspective, reductions in average waiting time and similar re-admission rate were noted in tele-COT compared to conventional COT. The average waiting time for pre- and post-discharge tele-COT was decreased by 36% (12 days to 7.65 days) and 14% (32.3 days to 27.8 days) respectively. A shorter waiting time for pre-discharge tele-COT was expected to facilitate earlier discharges during the in-patient phase, as patients could receive home modification advice and prepare their home environment sooner. For the 28-day hospital re-admission rates, it was decreased by 16% for tele-COT cases compared to conventional COT cases , at 0.25 and 0.29, respectively.
From the OTs' perspective, a reduction in intervention time was observed in tele-COT when compared to conventional COT. Each tele-COT session saved approximately 50% (or 45 minutes) of intervention time by reducing travel and administrative time. Consequently, this enhanced the efficiency of COT services provision.
Satisfaction surveys revealed that patients, caregivers and OTs had positive opinions towards the program. Patients and caregivers rated a total score of 4.4 out of 5, expressing appreciation for the timely interventions. However, some elderly expressed difficulties in using smartphones for tele-COT. Meanwhile, OTs also rated a total score of 4.4 out of 5, acknowledging the efficiency gained and manpower saved. However, some highlighted that tele-COT may not be suitable for cases requiring complicated home modifications, which require conventional approach instead.
In conclusion, the program was beneficial for both OTs and patients, facilitating timely interventions and early discharge while saving manpower. Furthermore, this innovative approach aligns with ongoing development of smart hospital. Overall, tele-COT represents an alternative to deliver COT services, while conventional COT continues to play a crucial role in addressing diverse types of cases. In the future, the program should include a larger patient cohort to gather additional feedback and identify areas for improvements.
