Family Medicine Specialist Clinics (FMSCs( FMSCs) ) in KWC. to reduce unnecessary referral to Medical SOPC

Transcription

1 Family Medicine Specialist Clinics (FMSCs( FMSCs) ) in KWC to reduce unnecessary referral to Medical SOPC 1

2 Dr. Ng Ching Luen MBBS, FRACGP, FHKCFP, FHKAM (Family Medicine) Department of Family Medicine and Primary Health Care, Kowloon West Cluster 2

3 Objectives of FMSCs 1) To act as gate-keeper of inappropriate referrals to SOPC 2) To act as safety net of the SOPC triage system (to avoid delay in diagnosis and management) 3

4 Objectives of FMSCs (cont d) 3) To provide/ enhance community-oriented care 4) To facilitate public-private interface (PPI) of health care system 4

5 4 FMSCs in KWC Cheung Sha Wan FMSC (CSW FMSC) East Kowloon FMSC (EK FMSC) Ha Kwai Chung FMSC (HKC FMSC) Yan Chai Hospital FMSC (YCH FMSC) 5

6 Parent Hospital and Special Investigations Available in Each FMSC FMSCs Parent Hospitals Special investigations available HKC PMH Upper GI endoscopy (OGD)*, ultrasound scan (USG), treadmill, lung function test YCH YCH OGD, USG, CT scan, treadmill, 24 hour holter, ambulatory BP monitoring. CSW CMC OGD*, USG EK OLMH OGD, USG, 24-hour holter, ambulatory BP monitoring * OGD services of HKC FMSC and CSW FMSC are provided by OLMH. 6

7 Referral System of FMSCs Triage nurses/ doctors of Medical SOPD select suitable non-urgent cases which are originally referred to them Fax referral letter to FMSC 2nd screening by FMSCs doctor If patient accepted by FMSC Patient will attend FMSC instead of Medical SOPD 7

8 Data Analysis Date of data analysis: 1st Jan 2007 to 10th Jan 2007 Data analysis of all the cases seen in the 4 FMSCs within the 1-year period (from Nov 2005 to Oct 2006) 8

9 Data Analysis (cont d) Totally 1083 patients had been seen in these 4 FMSCs from Nov 2005 to Oct

10 Number of Patients Seen in Each FMSC YCH 311 HKC 527 EK 119 CSW CSW EK HKC YCH CSW EK HKC YCH 數列

11 Referral Sources GOPD % SOPC % AED % Private doctors % Others % Total % 11

12 Referral Sources Private doctors 13% AED 12% SOPC 6% Others 0% GOPD 69% GOPD SOPC AED Private doctors Others 12

13 Comparison of Waiting Time for New Cases of Each FMSC and that of Medical SOPD of Parent Hospital No. of weeks HKC YCH CSW EK Medical SOPD (parent hospital) FMSC 13

14 Top 10 Commonest Reasons for Referral 1) Epigastric discomfort/ dyspepsia 186 (15.58%) 2) DM 130 (10.89%) 3) HT 97 (8.12%) 4) Chest discomfort 88 (7.37%) 5) Headache 73 (6.11%) 6) Palpitation 63 (5.28%) 7) Abnormal liver function tests 61 (5.11%) 8) Dizziness 37 (3.10%) 9) Dyslipidaemia 37 (3.10%) 10) GERD 19 (1.59%) 14

15 Outcome Analysis By Jan 2007, 784 patients (out of 1083 patients) had been case closed in FMSCs The average number of visits of these discharged patients was 2.52 (95% confidence interval: ) 15

16 Outcome of Patients Discharged to GOPD % Back to private doctors* % Defaulted FU % No need to FU % Death 2 0.3% Referred to SOPC % Total % * Totally 137 patients were referred from private sector, and 43 of them were referred back to these private doctors. Thus 31.4% of patients referred from private sector was subsequently discharged back to private doctors. 16

17 Outcome of Patients No need to FU 3% Referred to SOPC 21% Death 0% Defaulted FU 6% Back to private doctors 5% Discharged to GOPD Back to private doctors Defaulted FU No need to FU Death Referred to SOPC Discharged to GOPD 65% 17

18 Epigastric Pain / Dyspepsia (By Jan 2007, 124 patients with epigastric pain/ dyspepsia had been case closed) Case closed % Waiting for OGD % Waiting for USG 6 3.2% Still FU, no special Ix yet 8 4.3% Total % 18

19 OGD(n = 74) 13C Urea Breath test (private sector)(n = 3) Ultrasound (n=3) Referred to Surgical SOPC without special investigations in FMSC (n = 4) Referred to Medical SOPC(n = 1) Others(n = 39) Gastritis 50 Gastritis + Duodenitis + duodenal 1 diveticulum Intestinal metaplasia 2 Gastric ulcer 7 Duodenal ulcer 2 CA stomach 2 No abnormalities detected 10 Positive breath test 1 Negative breath test 2 Gallstones 1 Hepatic cysts 1 No abnormalities detected 1 Because of repeated rectal 2 bleeding (on further history taking) Because of change of bowel 1 habit (on further history taking) Because of anaemia (found in 1 initial blood test) Patient request (patient finally 1 preferred to wait for Medical SOPC rather than to wait for OGD in FMSCs) Case closed without special 39 investigations and referral Total 124 Majority were uncomplicated conditions 19

20 Epigastric Pain / Dyspepsia Cases: Implications (1) Majority were uncomplicated cases. (2) FMSCs can also pick up serious conditions. 20

21 Chest Discomfort By Jan 2007, 76 patients referred to FMSCs because of chest discomfort had been case closed 21

22 Majority were uncomplicated conditions Non-cardiac chest pain (n = 61) Case close without special investigations 61 and referral Referred to Medical SOPC without special investigations in FMSCs (n =3 ) Because treadmill test was not available in FMSCs before 1 st Sept 2006 Because of cardiac arrhythmia 2 1 Private CT coronary angiogram (private sector) (n = 4) Postive result 3 Negative result 1 OGD (n = 5) Gastritis 4 No abnormalities detected 1 Ultrasound (n = 3) Fatty liver 1 Liver cysts 1 No abnormalites deteced 1 Total 76 22

23 Achievements of FMSC 23

24 Achievements of FMSC 24

25 1) To Reduce Unnecessary Referrals to SOPC For the top few commonest reasons of referral, most were finally diagnosed to have uncomplicated conditions. For patient discharged, 79% of them did not need to be referred to SOPC. 25

26 2) Promoting Community Oriented Patient Care After appropriate investigations and initial management in FMSC, patients will have more confidence in receiving further management in their original GOPCs or private family doctors. 26

27 3) Better Access & Substantial Shorter Waiting Time The waiting time for new cases of FMSCs is usually between 2 weeks (HKC and CSW) and 9 weeks (YCH) Thus some significant disease can be detected earlier 27

28 4) Public-private interface A proportion of patients of FMSCs were referred to the private sector for some special investigations (eg CT coronary angiogram, 13 C Urea breath test) 31.4% of patients referred from the private sector were referred back to these private doctors 28

29 Conclusions FMSCs is a sustainable model Successful gate keeping function for SOPD 29

30 Acknowledgement Dr. Yiu Yuk Kwan Dr. Alvin Chan Chung Yuk Dr. Luk Wan Dr. Allen Ngai Ho Yin 30

31 31