Telemedicine consultation in Castle Peak Hospital (CPH) for stable psychiatric outpatients in custody (Dr Koi Man, Cheng)

Transcription

1 Telemedicine consultation in Castle Peak Hospital (CPH) for stable psychiatric outpatients in custody (Dr Koi Man, Cheng) (Consultant) (Castle Peak Hospital) (HA convention 2017) (16 May 2017)

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3 SECTION 1 INTRODUCTIO N

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8 To address the above problems, this study Aims at Assessing the benefits of using telemedicine consultation for a group of stable psychiatric outpatients in custody 8

9 In the US, a demonstration of utilizing telemedicine in prison in 1996 concluded that this practice is cost effective Effective substitutes for direct, inperson consultations in specialties like psychiatry A decline in violence incidents U.S. Department of Justice. Telemedicine can Reduce Correctional Health Care Costs: An Evaluation of a Prison Telemedicine Network

10 Telepsychiatry Psychiatric consultation and short-term follow-up can be as effective when delivered by telepsychiatry as when provided face to face (Richard O Reilly et al. Psychiatric Services 58; 2007) In a systemic review of telepsychiatry (Salmoiraghi et al. J Psychiatr Pract 21 (5); 2015), the findings are: 1. High patient satisfaction with positive attitude 2. Correlated with decreased admissions 3. Similar quality of clinical interaction to that of face-to-face care 4. Cost effective Telemedicine may be a useful alternative to face-to-face clinical visits for management of dementia patients in rural areas (Heeseok Kim et al. J Telemedicine & Telecare 23; 2017) 10

11 In Hong Kong, the use of telemedicine in psychiatry is not Videoconferencing was found to be feasible, acceptable to staff and patients and costeffective WK Tang et al, Telepsychiatry in psychogeriatric service: a pilot study; Int. J. Geriatr. Psychiatry 16 (2001) new 11

12 Opportunity CSD proposed to HA a pilot project ~ 2012 clinically stable psychiatric outpatients who are in the custody of CSD can choose to participate in real time and interactive telemedicine psychiatric consultation Pilot sites: Castle Peak Hospital (CPH) of HA and Lai Chi Kok Reception Centre (LCKRC) of CSD embarrassment and stigmatisation can be avoided

13 Deliberation Jun 2012 July 12 Jan 13 Jan Apr 2013 Telemedicine Liaison TG (CPH & CSD) Conducted survey in SOPC, CPH Performed demonstration at SOPC, CPH Consultation in COC(Psy) 12 Sept Oct 2013 Oct Nov 2013 Jan 2014 Meeting with Legal Section & Technology Management Section Presentation in HA Committee on Innovative Technology & Application Further advice from CISPO on the proposal was sought To present in SMM Submission to NTWC CREC 13

14 SECTION 2 Methodology

15 Hypotheses 15

16 Methodology Inclusion criteria Male outpatients in custody of CSD attending follow-up at CPH Aged between In stable psychiatric condition 16

17 Methodology Exclusion criteria prominent and recent change/deterioration in mental condition regular blood tests needed drug administration in SOPC required new to psychiatry service visual or auditory deficits, which may impair the ability to interact via videoconferencing 17

18 Period: 1 Jun 2014 to 31 May 2016 Written consent Methodolog y Matching: age-matched outpatients fulfilling the inclusion and exclusion criteria attending face-to-face consultation at other psychiatric SOPCs Maximum telemedicine attendance: 4 (face to face interview required for the fifth consultation) 18

19 SECTION 3 Measurement s

20 Measurements Demographics Standard of care: 1) Comparison of Pre-post GHQ difference between cases and comparison group for the first attendances- U test 2) Correlation of Pre-Post GHQ between the first and second telemedicine consultation sessions 3) Satisfaction survey 20

21 Measurements Satisfaction survey (Nine Likert scale (1-5) questions, total marks range from 9 (best) to 45 (worst) Significant adverse events Cost analysis 21

22 SECTION 4 Results

23 Results Total number of PICs attendance at CPH within the study period = 377 Number of attendance excluded because of exclusion criteria = 99 Number of attendance refusal (+/- reasons) = 49 Other reasons* of not attending telemedicine = 57 Total telemedicine attendance = 172 Total number of patients = 86 Total number of comparison group = 249 * Release from prison before FU (43) Fifth attendance (7) Relapsed soon before FU (2) Others (5) 23

24 Results Case (86) Comparison group (249) Age Mean SD Mean SD t P Pre-GHQ Education Primary >Secondary Primary >Secondary Primary Dx N % N % SA schizo affective others

25 Types of offence Category A (N=2) Sentence > 12years Need stronger strength of escort E.g. murder, manslaughter, trafficking of D.D. Non-Category A (N=84) Sentence < 12years E.g. Theft, Robbery, Common Assault

26 Pre-Post GHQ Case Comparison z p group N median Interquartile range 6 4 Correlation between 1 st and 2 nd teleconsultations N = 29 r p

27 Satisfaction survey Case N 86 Mean score SD 4.35 Duration of on air time One comment of slow connection N 86 Mean (min) 6.33 SD (min) 3.58 Median/Mode (min) 5 27

28 Save $1850 escort cost No significant adverse events 28

29 Discussion A significant proportion of PIC can be benefited from the service, which is safe and sustainable comparable to face-to-face interview in suitable patients Preferred by patients cost + public safety No significant adverse events 29

30 Limitations Lacks clinical outcome measures Small sample size Limited to stable, follow-up patients Male patients only 30

31 Way forward Set up more stations in CSD Recruit female patients Expand to other SOPCs 31

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33 All participating staff of CPH and CSD Acknowledgement All participating patients Names not listed in order Mr CW Yeung Mr Culex Tse Dr NM Kwong Mr CM Ho Ms Sylvia Choy Mr MH So Mr KW Chung Mr ST Wong Ms Cherie Au Yeung Dr Bonnie Siu Dr CK Tung Dr CF Tsui Mr Kenny Wong

34 THANK YOU!

35 Workflow Workflow of Telemedicine Consultation Study for Stable Psychiatric PICs in CPH ( ) for case group.pdf Workflow of Telemedicine Consultation Study for Stable Psychiatric PICs in HA Psychiatric Centre ( ) for control group.pdf 35