Authors (including presenting author) :
WONG LF(1), LI CML(1), YUEN YC(1), WONG HK(1), KWOK WMM(2), NG SW(3), CHOY CFF(1)
Affiliation :
(1) Respiratory Specialty, Department of Medicine, Tseung Kwan O Hospital,(2) Nursing Service Division, Tseung Kwan O Hospital, Hospital Authority, HKSAR,(3) Nursing Service Division, United Christian Hospital, Hospital Authority, HKSAR
Introduction :
For burden of Chronic Obstructive Pulmonary Disease (COPD), the unplanned readmission rate of medical admission related to COPD acute exacerbation remained high and counted for around 30-38% from 2019-2021 in HAHO. In 2022, COPD was the cause of 622 episodes of hospitalizations in Tseung Kwan O Hospital. In order to manage the demand and enhance the care of COPD patients. Integrated Model of Specialist Outpatient Service through Medical Nurse Clinic (IMSN)-COPD was implemented in Tseung Kwan O Hospital (TKOH) since Oct,2021. This is to review the delivery model in COPD nurse clinic to provide better continuity of care.
Objectives :
1.To establish IMSN-COPD nurse clinic in TKOH 2.To preliminarily review the effectiveness of IMSN-COPD nurse clinic in TKOH
Methodology :
IMSN-COPD nurse clinic has been established with key components as follows: (1) initial assessment, (2) self-management plan, (3) discharge bundle care and (4) evaluation of disease outcomes.
Result & Outcome :
From Oct 2021 to Sep 2022, a total of 346 patients were recruited, with mean age of 73.25 and 96% males. According to GOLD guideline for risk stratification, these COPD patients were categorized in Group A (23.4%), Group B (48.8%), Group C (6.36%) and Group D (21.4%) respectively. There were 78.6% (p=0.003, paired t-test) and 55.3% (p=0.000, paired t-test) reduction in AED attendance after 3 months attended IMSN-COPD nurse clinic in Group C and Group D patients respectively. Focusing on symptoms control, there were significantly improvement in both group B and group D patients. For group B patients, CAT mean 3.21±5.78 (p=0.000, paired t-test). For group D patients, CAT mean 4.18±9.83 (p=0.003, paired t-test). The inhaler technique and knowledge, after 3 months IMSN-COPD nurse clinic attendance show improvement: 61.1% in MDI technique, 24% in MDI knowledge, 33.8% in DPI technique, 20% in DPI knowledge, 35.1% in SMI technique and 20% in SMI knowledge. There is significant improvement (p=0.000) on compliance of the test of Adherence to inhaler (TAI), comparing the first and after 3 months attendance. Good compliance 257 (74.1%), medium 69 (19.9%) and poor compliance 21 (6.1%) versus good compliance 264 (88%), medium 30 (10%), poor compliance 6 (2%). A total of 198 patients responded over 346. Majority of patient expressed that they satisfied with their own treatment plan, with an average score, 3.64 out of 4. Regarding to the nurse clinic service and attitude of healthcare worker, patients expressed positively with an average score, 3.73 out of 4. In conclusion, Integrated Model of Specialist Outpatient Service through Medical Nurse Clinic (IMSN)-COPD was effective in enhancing patients’ inhaler compliance, technique and knowledge, reducing healthcare service utilization, and achieving stabilization of symptoms control.
