dr. felix h w chan dr. james k h luk dr. l w chu prof. timothy kwok prof. daniel t p lam
DESCRIPTION
Response of Primary Care Doctors And Geriatricians to the “ Building a Healthy Tomorrow - Discussion Paper on Future Health Service Delivery Model ” for Residential Care Homes for the Elderly. Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam. - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/1.jpg)
Response of Primary Care Doctors And Geriatricians Response of Primary Care Doctors And Geriatricians to the “Building a Healthy Tomorrow - Discussion to the “Building a Healthy Tomorrow - Discussion Paper on Future Health Service Delivery Model” Paper on Future Health Service Delivery Model”
for Residential Care Homes for the Elderlyfor Residential Care Homes for the Elderly
• Dr. Felix H W Chan• Dr. James K H Luk• Dr. L W Chu• Prof. Timothy Kwok• Prof. Daniel T P Lam
![Page 2: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/2.jpg)
Time for ChangeTime for Change
• Sustainability• Affordability• Accessibility• Quality
![Page 3: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/3.jpg)
Future Health Care Future Health Care Delivery ModelDelivery Model
Tertiary Hospital Centres / Networks
District-based Hospital Services
Hospitals
Accident andEmergency
Departments
SpecialistOut-patient
Clinics
District-based Primary Care
Family Doctors
ElderlyCare
Services
Long-term andRehabilitationCare Services
![Page 4: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/4.jpg)
RecommendationsRecommendations• The Family Doctor concept is emphasized• Primary care doctors as Visiting Medical Office
rs ( VMOs ) to take up gate-keeper’s role• Revision of the Code of Practice for RCHEs by S
WD – engaging primary doctors to take care of the residents’ medical needs
• CGATs to concentrate on discharge planning and providing support to VMOs through consultations & case conferences
![Page 5: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/5.jpg)
ObjectivesObjectives
• To examine the response of primary care doctors & geriatricians to the recommendations • To explore the feasibility of engaging primary care physicians in looking after the basic medical needs of residents in RCHEs on a regular basis• To determine the support needed to enable primary care doctors to take up the role as “gate-keepers”
![Page 6: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/6.jpg)
MethodologyMethodology• Postal questionnaire survey• Participants:
1. Holders of Post-graduate Diploma in Community Geriatrics (PDCG) of HKU & CUHK2. Visiting Medical Officers (VMOs) - Phase 1,2 & 33. Fellows in Geriatric Medicine
![Page 7: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/7.jpg)
Questionnaire contentQuestionnaire content
1. Part A : Demographics – Q1 82. Part B : Past experience of VMOs – Q9 1
33. Part C : Determine % doctors willing to t
ake up VMOs’ duties & their commitment – Q14 16
4. Part D: Response to recommendations of HWFB’s
paper – Q17 185. Part E : Key success elements for primar
y care doctors to take up RCHE duties – Q19 22
6. Part F : Support required for VMOs – Q23 25
![Page 8: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/8.jpg)
ResultsResults
• No. of questionnaires posted – 404• Overall response rate – 42.3%
(171/404)• Primary Care doctors’ response rate –
42.6% (113/265)• Geriatricians’ response rate – 41.7%
(58/139)
![Page 9: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/9.jpg)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
Geriatricians
Primary doctors
66%
34%
![Page 10: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/10.jpg)
Present working organization
41.5%
8.2%
36.8%
7%
1.2%
5.3%
![Page 11: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/11.jpg)
Experience of working as Experience of working as Visiting Medical OfficerVisiting Medical Officer
![Page 12: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/12.jpg)
Have you ever been a visiting medical officer (VMO) in homes for the elderly ?
56.1%
43.9%
56% have been a VMON=96
![Page 13: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/13.jpg)
During your term as a VMO have you ever worked with the Community Geriatric Assessment Teams (CGATs) ?
63.4%
71.4%
61.1%
36.6%28.6%
38.9%
61.1% primary doctors have worked with CGAT
![Page 14: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/14.jpg)
Willingness/ Commitment of Willingness/ Commitment of taking up VMO’s dutytaking up VMO’s duty
![Page 15: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/15.jpg)
Will you be able to devote your time to look after the medical needs of a home for the elderly on a regular basis ?
73.1%
84.7% 26.9%
15.3%
84.7% primary doctors able to devote time 50% geriatricians able to devote time
![Page 16: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/16.jpg)
Will you be able to provide 24 hour medical support to the homes for the elderly on a
regular basis ?
16.7%
83.3%
16.7% primary doctors agreed10.7% geriatricians agreed
10.7%
![Page 17: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/17.jpg)
Views on Recommendations Views on Recommendations made in the Discussion Papermade in the Discussion Paper
![Page 18: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/18.jpg)
Engaged VMOs should attend to the basic medical needs of the RCHEs on a regular basis
P<0.05
56%
35.7%
63.4%
43.9%
Almost all doctors agreed
![Page 19: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/19.jpg)
Social Welfare Department to revise the Code of Practice for RCHEs to engage doctors to take care of their residents’ medical needs on a regular basis
P<0.01
31%
64.3%
95.3% doctors strongly agreed or agreedMore geriatricians strongly agreed (45.6%)
![Page 20: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/20.jpg)
Geriatricians in HA should focus more in hospital work rather than RCHEs
P<0.001
27.7%
31.3% 32.5%
8.4%
Obvious disagreement between geriatricians and primary doctors64.2% geriatricians disagreed or strongly disagreed70.9% primary doctors agreed or strongly agreed
![Page 21: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/21.jpg)
CGAT should concentrate on discharge planning and provide support to doctors engaged by RCHEs through consultations and joint conferences
P<0.01
30.5%
61.1%
6.6%1.8%
97.3% primary doctors strongly agreed or agreed19.3% geriatricians strongly disagreed or disagreed
![Page 22: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/22.jpg)
Private doctors can act as gatekeepers of A & E attendance and hospitalization for all RCHE residents
P<0.001
37.3%
44.4%
13%
5.3%
94.6% primary doctors strongly agreed or agreed43.9% geriatricians strongly disagreed or disagreed
![Page 23: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/23.jpg)
Do you consider medical care given to RCHEs a primary care or secondary care service ?
P<0.053%
34.7%
59.9%
2.4%
59.9% doctors considered both primary and secondary
![Page 24: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/24.jpg)
Success elements for VMOsSuccess elements for VMOs
![Page 25: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/25.jpg)
Success elementsSuccess elementsin order of importancein order of importance
1. Time that the VMOs can spend in RCHEs for consultation on each visit ( 90.5%)
2. Frequency of VMOs’ visit ( 88.1% )3. VMOs’ financial return from RCHEs
work ( 85.8% )4. Experience of working with CGATs (
83.9% )5. Possession of a PDCG/DGM qualifica
tion ( 72.7% )
![Page 26: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/26.jpg)
Support required by VMOsSupport required by VMOs
![Page 27: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/27.jpg)
Support required Support required in order of importancein order of importance
1. Access to HA Clinical Management System record ( 97.1% )
2. Referral right to HA community nursing and allied health professionals ( 93.6% )
3. Right of ordering investigations in HA laboratories ( 80.0% )
4. Right of prescription in HA pharmacy ( 72.9 %)
5. Right of admission to HA hospitals ( 67.8% )
![Page 28: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/28.jpg)
DiscussionDiscussion• Primary care doctors & geriatricians wer
e receptive to change• Further understanding and division of la
bour between primary care doctors & geriatricians on their respective roles in meeting the needs of RCHEs are needed
• Pertinent questions on health care financing not answered – ? financial incentives for private doctors
![Page 29: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/29.jpg)
LimitationsLimitations
• Response rate (42.3%)• Sampling – only primary doctors who ha
d PDCG or VMOs’ experience• The views of managers/ front-line staff &
residents of RCHEs should also be studied
![Page 30: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/30.jpg)
05
1015202530354045
1 2 3 4 5 6 7 8 9 10 1112 1 2 3 4 5 6 7 8 9 10
Months 93/94
Nu
mb
er
Why CGAT began ? Why CGAT began ?
Buddhist Li Ka Shing C&A Home: Number of attendance to the AccideBuddhist Li Ka Shing C&A Home: Number of attendance to the Accident and Emergency Departmentnt and Emergency Department
![Page 31: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/31.jpg)
When/Where CGAT began ?When/Where CGAT began ?
![Page 32: Dr. Felix H W Chan Dr. James K H Luk Dr. L W Chu Prof. Timothy Kwok Prof. Daniel T P Lam](https://reader035.vdocuments.net/reader035/viewer/2022062423/56814e8f550346895dbc353d/html5/thumbnails/32.jpg)
AcknowledgementAcknowledgement
• Dr T K Kong (PMH)• Dr. S Y Au (TMH)• Dr. M H Chan (KWH)• Dr. MH Kong (PYNH)• Dr. B C Tong (PMH)• Dr. H C Yuen (TMH)• Dr. K Y Lam (KWH)
• Dr. C P Wong (RH)• Dr. M F Leung (UCH)• Dr. K H Or (SH)• Dr. C K Mok (TMH)• Dr. S L Szeto (KWH)• Dr. P S Ko (AHNH)