Authors (including presenting author) :
Lo YM, Chou PK, Hung SY, Cheung PH, Cheung YHK, Tsui PN, Cheng KW, Keung LF, Chan TK, Li HLF, Leung WMM, Wong MYM, Wong MSM
Affiliation :
Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster
Introduction :
Teleconsultation has emerged during the COVID pandemic as a means to improve healthcare services in rural areas. In the Hong Kong East Cluster, three clinics are located on outlying islands (OLI). Patients may face long travel times to access programs that are only available in urban clinics. The Risk Assessment and Management Program (RAMP) for poorly controlled diabetes (DM) patients has in operation in urban clinics for years.
Objectives :
1. To optimize the key performance indicators of OLI patients with poorly controlled DM through teleconsultation.
2. To expand the coverage of existing services from urban clinics to rural clinics.
Methodology :
A workgroup comprising doctors, nurses, and clerical staff was established to discuss the logistics and setup of the teleconsultation service in OLI clinics. Staff training was conducted, and a guidebook was prepared for reference. Before the launch, a drill was conducted to test and fine-tune the logistics. Tele-RAMP doctor consultations commenced in Peng Chau (PC) and North Lamma (NL) GOPC from February 2024. Poorly controlled OLI DM cases were referred to the Tele-RAMP doctor consultation according to the RAMP protocol. Quotas were reserved at urban clinics; patients would only attend OLI clinic as usual but would be managed by an Associate Consultant from the urban clinic through Tele-RAMP consultations.
On follow-up days, clinic staff instructed patients to go to the telehealth station for their medical consultations. Staff assisted patients in logging into HA Go and connecting to the telehealth function. OLI nurses provided nursing interventions to patients after the teleconsultation.
Result & Outcome :
From February to December 2024, 18 and 14 patients received teleconsultation in PC and NL GOPC, respectively. Among the 32 patients, 77.4% had their post-teleconsultation HbA1c checked, with a significant reduction observed. Of the 77.4% of patients, 75% showed improvement in HbA1c: the average HbA1c reduction was 1.18%. Specifically, 37.5% of patients decreased their HbA1c by 0.1% to 0.9%, 25% by 1% to 1.9%, and 12.5% by 2% to 3.7%. Furthermore, 46.9% of patients rechecked their lipid profiles after the teleconsultation; among these, 66.7% showed improvement in low-density lipoprotein levels. Additionally, a patient experience survey was conducted, yielding positive results: 55% reported being very satisfied with the service. All patients agreed that staff provided a clear introduction to the service and that the teleconsultation process was smooth. They appreciated that clinic staff promoted and taught them how to use HA Go, found all information and support very helpful, and recognized that teleconsultation helped them better understand their chronic disease and manage it effectively.
Teleconsultation has enabled healthcare providers to fill existing service gaps.
