Authors (including presenting author) :
Yau KS(1), Chan TB(1), Choi YK(1), Ng TK(1), Leung WK(1), Leung KWM(1)
Affiliation :
(1)Department of Family Medicine, Prince of Wales Hospital(NTEC)
Introduction :
In Hong Kong(HK), waiting time for booking routine new cases at public SOPD is overwhelming. In 2021, waiting time for Medicine specialty in HK was 122weeks(90th percentile). Consequently, Policy Address 2022 set a target to reduce waiting time for Medicine specialty by 20% in 2023–24(i.e.97weeks). One strategy to reduce waiting times is on upstream management in lowering the referral rate. Hence, we piloted Associate Consultant Clinic(ACC) service(Phase 1) in three Shatin district GOPCs since 8/2020. The ACC was designed to enable Family Medicine specialists to re-evaluate cases that might otherwise have been referred to SOPD. With collaboration with Medicine/Pathology/Radiology, certain special investigations(e.g.Holter/treadmill/ultrasound liver/laboratory test anti-ENA Ab,etc.) were made accessible in ACC to help making the diagnoses at primary care settings. In 2/2023, ACC service was expanded(Phase 2) with an increase in service capacity, and inclusion criteria were broadened from 4 to 11 indications(ie,chest pain/palpitations/atrial fibrillation/sinus bradycardia/headache/dizziness/deranged liver/renal function/dyspepsia/chronic cough/elevated autoimmune markers/poor control of two or more chronic diseases). The sources of new cases for ACC were expanded to include Accident and Emergency department and SOPDs.
Objectives :
To evaluate the effectiveness of ACC service.
Methodology :
ACC service from 4/2023-3/2024 was evaluated. Data was retrieved from CDARS and CMS, and was analyzed with Excel.
Result & Outcome :
ACC service served 1506 individuals with 3,037 attendances from 4/2023-3/2024. 43% of these were new cases. 95% of cases were seen within 8 weeks(with an average of 4weeks). The top three conditions treated were chest pain/palpitations, deranged liver function, and poor control of two or more chronic diseases, which accounted for 72% of the cases. For outcome evaluation, 82% of cases were closed within three visits, indicating the ACC service's efficiency. Of the cases that were closed, 73% were managed at the primary care level, significantly alleviating referral load to SOPD. Regarding impact evaluation, referral rate to MSOPC has significantly reduced by 30% compared to that prior to ACC(0.93% in Jan-Jul 2020 vs 0.65% in 4/2023-3/2024, chi-square test p< 0.001).
With the enhancement in assess to investigations, ACC service is shown to be effective in reducing referral rates and alleviates the burden on MSOPC. Expanding such model to support other SOPCs should be explored in the future.
