Authors (including presenting author) :
WONG MC(1), PANG PF(1)
Affiliation :
(1) Department of Psychiatry, United Christian Hospital
Introduction :
The psychogeriatric (PG) team has been providing psychiatric outreach service to residents of residential care home for the elderly (RCHE) in all clusters of the Hospital Authority (HA). However, after 2009, no resource was allocated to further extend this service to cover new RCHEs. A number of privately-run-RCHEs were opened in the Kowloon East Cluster (KEC) in the past fifteen years. The residents would need to attend the three psychiatric Specialist Outpatient Clinics (SOPCs) of our cluster for in-person psychiatric follow-up. Because of operational limitation, they are under the care of different doctors scattered in different SOPC sessions. All residents need to be escorted to our SOPCs as most of them have mobility or cognitive problem. We notice that very often, the escort staff was not a staff of the RCHE so they know little about recent condition of the patients. The attending doctor would need to call the RCHE during consultation and it would take a while to get through to the staff who are caring for the particular patient.
Objectives :
Telehealth is a form of patient care delivered through telecommunication with audio-visual devices (e.g. smartphone, tablet, and computer, etc.) via video conferencing software (e.g. Zoom) or applications (e.g. HA Go)(1). When HA was promoting the use of telehealth in SOPC setting in 2023, we planned to make use of it to improve the quality of service provided to this group of patients and to bring convenience to them and to our doctors.
Methodology :
We confirmed the number of RCHEs within KEC without PGT outreach service by referring to the Social Welfare Department Elderly Information Website (2). Sixteen RCHEs were contacted for their willingness to join this telehealth programme. Fifteen of them agreed to join and they had the necessary equipment on-site for telehealth. One RCHE declined to join due to the lack of manpower to arrange telehealth. The RCHE staff helped to obtain the consent from patient or their carers for telehealth. With the help of the RCHE staff, we had obtained the number of residents who were under the care of our SOPCs. There were about 170 patients. We had assigned five doctors to join this programme and each of them would look after a few RCHEs. Four of the doctors were PG specialist. Follow-up schedule was arranged for these RCHEs starting from April 2024 with reference to the PGT outreach schedule. Telehealth of residents of each RCHE was grouped together in the same session under the same doctor. A secured Zoom link was used and a staff member of the RCHE helped to bring the telehealth device to the proximity of patient under telehealth service. The designated RCHE staff caring for the patient was preferred to do the reporting. Any family member was welcomed to join the telehealth. The patients were seen one by one. After the session, the RCHE staff came to the SOPC to collect drug prescriptions of all the patients in one go. Telehealth to face-to-face assessment would be arranged by a ratio of no greater than 4:1 according to the HA guidelines (1).
Result & Outcome :
From April to November 2024, the total telehealth attendance was around 280. A survey was done to collect feedback from both RCHE staff and doctors involved in this telehealth programme in December 2024. Both parties agreed that the program have brought convenience to the patients who have mobility problem and have reduced their need to travel and to wait in SOPCs which could be tiring for them. All RCHEs preferred the new arrangement. As for the quality of telehealth consultation, doctors opined that they were able to see and hear the patients clearly through telehealth. An extra advantage is that the doctor could have direct communication with the staff who takes care of the patients. Nearly all RCHEs appreciated the arrangement that a designated doctor was assigned to take care of the home. Psychoeducation about use of medications and behavioral management could be conducted more easily. Doctors could also identify the strengths and weaknesses of the RCHE they are taking care of. More specific advice could be given to them and this could benefit other residents of the home as well. These homes are also invented to join the regular educational talks and workshops organized by the PG team targeted for RCHEs. The connection with these homes has been strengthened as a result of this telehealth programme without extra resource. With the development of HA Go institution account, the use of telehealth can be through HA Go instead of zoom for the RCHE residents in the near future. Since the Multi-Disciplinary Outreaching Support Teams for the Elderly has been providing services to private RCHE residents, further collaboration with them would be explored to ensure that the mental health needs of residents can be fulfilled through a multi-disciplinary approach. A designated community psychiatric nurse can be assigned to take up referrals for following up patients in the same RCHE. This would bring extra benefit as skills transfer can be conducted on-site at the homes.
Reference:
1. Guidelines on Provision of Telehealth (teleconsultation and televisit) Service by Psychogeriatric Service. HAHO, 2023.
2. https://elderlyinfo.swd.gov.hk/tc/ltc_search/rcs
3. https://www.swd.gov.hk/storage/asset/section/362/en/Multi-disciplinary_Outreaching_Support_Teams_for_the_Elderly_(MOSTE)_Leaflets_2023_w3c.pdf
