seminar 4 講座四 community mental health in action ... · pdf fileseminar 4 講座四...

Seminar 4
Community Mental Health in Action Collaboration And Innovation
11
IntegratedMentalHealthProgrammeAProactiveApproachFor
PeopleWithCommonMentalDisorder(CMD)inCommunity
OttomarkChitungNG,ProgrammeManager,St.James
Settlement
HKECSymposiumonCommunityEngagementVIIIMentalWellness
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ANewFocusinCommunityEngagement

HKEC IMHP is a joint project between Department of Family Medicine & Primary Health Care and a community partner (St. James Settlement) to provide early detection and early intervention to patients presenting with anxiety and/or depressive mood at FMSC-GOPC, and continued treatment to patients stepped-down from PSY SOPD.
Service Commencement: SWH: March 2010 CW: Nov 2010 VP: Sep 2011
22HKECSymposiumonCommunityEngagementVIIIMentalWellness
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Poor Disease Management
Health Deteriorating
Further deteriorating in Mental Health
ChronicillpatientsIMHPIntervention
Depressive Mood
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ServiceReviewof IntegratedMentalHealthProgramme
in HongKongEastCluster
Dr.SinMC(1),Dr.LamCYJ(1),MsWongMFM(1),MsSoMY(1),Dr.ChuWS(1),MsYungMT (2)
(1)Department
ofFamilyMedicine&PrimaryHealthcare,(2)St.James
Settlement
44HKECSymposiumonCommunityEngagementVIIIMentalWellnessWithout
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Data analyses & results prepared by: Ms Wong MFM (Clinical Psychologist) & Ms So MY (Psychology Assistant)
Data collection by St. James Settlement Key Workers: Mr. Ottomark Ng, Ms Cathy Li & Ms Sharon Chui
Clinical operation & logistics coordination by various doctors & nurses in Chai Wan, Sai Wan Ho & Violet Peel GOPCs
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IMHP Services IMHP Doctor & Key Worker Clinical Psychologist Psychiatrist Multidisciplinary Case Conferences
PSY SOPD Stepdown [No. : 146]
GOPC/ FMSC [No. : 1396]
1
IMHP Cases Discharged [Total No. : 904] Step up to PSY SOPD
[No. : 95]
Withdrawn / refuse by Patient [No. : 97]
IMHP Services Completed [No. : 712]
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Design: Pre Post: Session 1 (or 1st with data) vs Last (or Last with data)
Clinical Outcomes: GAD7 total scores (GAD7_Total) PHQ9 total scores (PHQ9_Total) PHQ9 Question No. 1, 2 & 9 (PHQ_Q1, Q2 & Q9)
Clinical Outcomes Descriptive Information: GAD7 Groups: Normal, Mild, Mod, Mod-Sev, Severe PHQ9 Groups: Normal, Mild, Mod, Severe
Patient Characteristics: demographics, CMOs diagnosis
Services Delivered77HKECSymposiumonCommunityEngagementVIIIMentalWellness
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Service reviewed in Jan 2013
Objective To evaluate clinical outcomes of patients having received
IMHP services; To evaluate service effectiveness of IMHP, via using using
service utilization data
Source of data: Number of patients with outcome data collected by Key
Worker (from 20 Mar 2010 to 20 Nov 2012) First date with data:
SWH: March 2010 CW: Nov 2010 VP: Sep 2011
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GenderDistribution Frequency PercentMale 310 34.3
Female 594 65.7
Total 904 100.0
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Mean 60.82Median 61.00Mode 63
Std.Deviation 14.07
Range 18
96
Age Frequency Percentunder20 6 .72130 18 2.03140 44 4.94150 120 13.35160 245 27.16165 133 14.76670 96 10.67180 175 19.48190 63 7.091100 4 .4Total 904 100.0
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Progress of patients was monitored in monthly Multi- disciplinary Case Conferences, involving: IMHP service providers (FM Specialists, Key-workers who
were R. Social Workers), clinic nurses, and consultation from
Psychiatrist & Clinical Psychologist (Starting Sep 2012)
1313HKECSymposiumonCommunityEngagementVIIIMental
WellnessWithoutBoundary
ANewFocusinCommunity
Engagement

The following analyses of outcome measures were based on the total no. of patients who have discharged from IMHP services (N = 904, for 3 clinics), by 20 Nov 2012 including: IMHP services completed: 712 Withdrawn / refused by Patient: 97 Stepped up to PSY SOPD: 95
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Clinical Outcome Measures: GAD7 total scores (GAD7_Total): improved after IMHP services
(statistically sig, p

1616HKECSymposiumonCommunityEngagementVIIIMentalWellnessWithout
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A
New
Focus
in
Community
Engagement

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2020HKECSymposiumonCommunityEngagementVIIIMental
WellnessWithoutBoundary
ANewFocusinCommunity
Engagement

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Selection of Pts appropriate, as reflected by Pts diagnoses: Insomnia (8%) Adjustment (8%) Anxiety Disorder (23%) Anxiety - Depression (25%) Depressive mood / Disorder (34%)
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No.ofdata:302

Services utilization: Duration of services (months): Mean = 4.3 + 4.6 No. of Doctor sessions: Mean = 2.1 + 2.7 No. of Key Worker sessions: Mean = 3.1 + 2.6
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ActionBasedonResults
Level1PHQ9:1014GAD7:59
Level1PHQ9:1014GAD7:59
Level
2
PHQ9:1519GAD7=1015
Level
2
PHQ9:1519GAD7=1015
Level
3
PHQ9:2027GAD7=1621
Level
3
PHQ9:2027GAD7=1621
Anti-Dep or PST-PC
Consult Psy. if insufficient response
Behavioral Activation
Relapse Prevention Education
Medication Compliance Encouragement if in treatment
Outcome tracking
Supportive counseling
Rescreening in one month
Refer Psychiatry
For PHQ9 score 5-9, Depression Resource Packet will be given.2626HKECSymposiumonCommunityEngagementVIIIMentalWellness
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Multi-disciplinary Collaboration
CollaborativeCare
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Step-up mechanisms were appropriate:
When patients mental state and mood problems need specialist medicine from psychiatrist, they were referred to PSY SOPD: 10% of discharged cases
When patients anxiety or mood problems were likely complicated by other comorbid disorders and/or personality issues, they were referred to FMSC-GOPC Clinical Psychologist for individual treatment
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Engagement

The IMHP in HKEC was shown to be effective in management of CMD in multidisciplinary service model, primary care team was empowered to manage CMD patients with effective utilization of health care resources.
The monthly multi-disciplinary case conference served as an effective communication platform between different professions.
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Q & A
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3131
!THANKYOU!
HKECSymposiumonCommunityEngagementVIIIMentalWellness
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Forenquiries,pleasecallOttomarkNgon81006537oremail:[email protected]

DrSession
KWSession
KW Telephone
SessionService
Duration(days)
Service Duration
(mths)
Range 0 -
16 0 -
20 0 -
5 0 -
734 0 -
24.5
Mean2.13 3.

seminar 4 講座四 community mental health in action ... · pdf fileseminar 4 講座四...

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