Authors (including presenting author) :
Lai WNE(1), Ho CY(1), Ma KY(1), Tang WS(1), Law OK(1)
Affiliation :
(1) Department of Surgery, Yan Chai Hospital
Introduction :
In 2023, the KWC Medical-Social Collaboration Committee (MSC) invited the Tsuen Wan District Health Centre (TWDHC) and Yan Chai Hospital (YCH) metabolic and bariatric surgery team in developing a pilot program on weight management service.
The YCH bariatric team was founded in 2015, aimed at providing multidisciplinary care for patients who are obese or overweight, to control weight and prevent development of severe health consequences, such as metabolic syndrome, myocardial diseases or cancers. The clinic was co-operating by bariatric surgeons and bariatric nurses.
Bariatric nurses possesses knowledge in weight management principles. In nurse clinic, we promote health and empower patients with knowledge and confidence, that patient can also maintain their health effectively with the right method: regular exercise and diet control. Nurses will also provide assessment on patients' current lifestyle and perform body composition examination. Suggestions and recommendations will be provided to modify current lifestyle according to the body composition report. After nurse clinic session, medical consultation will be provided by bariatric surgeon. Allied health care professionals (physiotherapist, dietitian, clinical psychologist) will be referred for further interventions after first visit to the bariatric surgery clinic.
In current service at YCH, patients are required to queue for around 50 weeks to first attend the bariatric surgery clinic. Further 4 to 12 weeks after clinic attendance is required to first attend allied health services.
In the pilot program, the TWDHC will provide 8 guaranteed weight management classes for patients referred by YCH bariatric clinic. The classes comprises of counseling, diet education and exercise coaching classes, held by allied health professionals of the TWDHC.
Most nurses in Hospital Authority are providing secondary care for patients. With the government promotion of Primary Health Care Blueprint and governance by the KWC CHC, nurses have the opportunity to work with the community stakeholders. In the pilot program, nurse act as coordinator role among the multidisciplinary team to ensure the program was running on track. And the precious opportunity allows nurses to plan, draft, implement and evaluate programs with incorporation of community resources, to maximize patients benefit and wellness.
In the future, with caring heart and expertise in clinical services, nursing profession can be continually developed via different partnership program with the community or other parties, and promote Hong Kong's excellence in healthcare service to the world.
Objectives :
To utilize and maximize usage of community resources for management of patients with obesity who indecisive for bariatric surgery
To improve patient experience with lifestyle modification with community support
To promote clients empowerment with early intervention by physiotherapists and dietitians on lifestyle modification
To improve patient’s outcome and satisfaction on weight management in 1 year
Methodology :
First, data collection and analysis of Hospital service was reviewed and service gaps were identified.
Then, bariatric nurse liaised with surgeons in setting up inclusion and exclusion criteria.
Visit was arranged to TWDHC for further discussion on the details of referral workflow, duration of pilot program and follow-up arrangements.
Drafted by bariatric nurse, the workflow of pilot program was set after reviewed by all parties.
Powerpoint presentation of the pilot program at the KWC MSC committee meeting was endorsed by chairman, the Hospital Chief Executive. The pilot program was agreed to be started in 3Q2023 and target population aimed at 20-30 patients.
New cases were reviewed by bariatric nurse prior to patients' first attendance to facilitate referral. Nurses have the autonomy to screen, suggest and promote suitable cases to participate in the pilot program. Designated checkboxes were applied in assessment form to facilitate communication between nurses and surgeons. The TWDHC will contact consented patient for registration and booking of designated weight management program in around 5 working days.
An encrypted excel file was generated to collect data and only accessible by YCH nurses and surgeons. Data were collected for reviewing program as well as patients' progress. First follow up at bariatric clinic will be around 6 months since first visit to allow interventions at the TWDHC.
Besides, interim meetings with TWDHC in March and August 2024 were arranged to review referral mechanism and discussed on future service enhancement.
The pilot program was reported in 3Q2024 to the KWC MSC meeting and will be continued.
Result & Outcome :
At 3Q2024, a total of 24 cases agreed referral to the TWDHC program
10 cases attended TWDHC programs and attended 1st follow-up in YCH Bariatric Clinic.
5 out of 10 attend patients showed weight loss ranged from 1.5% - 6.7%, where 4 of them showed muscle gain and fat loss in body composition assessment
2 cases reported effective weight loss as attended TWDHC and home exercise with diet modification.
The remaining 14 cases pending 1st follow up in YCH for body composition and assessment.
Hiccups were managed during the interim meetings with TWDHC.
1. Patients reported difficulty in registering TWDHC classes, TWDHC managed to held classes on weekly basis and shortened waiting time for joining pre-register classes.
2. As 5 cases did not register TWDHC member after referral, YCH nurses will reinforced cases to alert of calls from TWDHC for registration.
