Authors (including presenting author) :
HUI LC, TSE TK, YIP PC, LAU WH, KOO WY, YIP KY, KWAN KM, LEUNG SH, CHEN XRC, LI YC
Affiliation :
Department of Family Medicine and GOPC, Kowloon Central Cluster (KCC)
Introduction :
Patients with diabetes mellitus (DM) are more likely to get COVID-19 infection. Those COVID-19 patients with uncontrolled diabetes had a particularly high mortality rate. However, fear of exposure to COVID-19, difficulty in accessing clinical services and poor lifestyle may cause late clinical presentations or delay in assessment of diabetes complications and, hence, further worsening their chronic diseases control.
Objectives :
1. To identify service gaps in DM service during COVID-19 pandemic.
2. To implement changes to improve DM service.
3. To assess for improvement in clinical outcomes after implementation of changes.
Methodology :
Data of DM patients managed in 13 GOPCs of KCC were retrieved from the Statistical reports of Statistics & Data Science Department, Strategy & Planning Division, HAHO. The first phase data analysis was performed from 3rd Quarter (3Q) 2018 to 3Q 2019 which identified a deterioration in DM management. Departmental meetings were carried out to find out the service gaps or obstacles behind.
From 3Q 2019, different interventions were implemented to enhance DM service:
1) Online departmental-wide staff engagement: Series of online videos and educational meetings focusing on updated DM management & services were conducted.
2) E-resources for patient empowerment: Online community resources about home exercise were promoted with the use of QR Codes & HA DM Care Mobile Apps.
3) Data-driven approach in DM control monitoring: lists of DM patients with no annual HbA1c tests for DM control assessment were sent to individual clinics. Patients were advised for re-arrangement of annual investigations based on individual risk assessment.
4) Maintenance of a sustainable service: Drug Refill service was developed which provided a choice for stable DM patients to have their chronic medications refilled. On the other hand, patients with poorly controlled DM were strongly advised to turn up in person for medical assessment in a New Normal.
Data analysis were carried out in the same way in 3Q 2020 to assess if there had been any improvement in DM care after the implementation of changes.
Result & Outcome :
From 3Q 2018 through 3Q 2020, total number of DM patients managed in 13 GOPCs of KCC was increased from 50,039 to 54,185 (increased 8.3%) and DM patients with annual HbA1c tests performed was slightly dropped from 95.6% to 94.2% (P<0.001). Data analysis from 3Q 2018 to 3Q 2019 showed a significant deterioration in DM control. Percentage of DM patients achieved target HbA1c of less than 7% dropped from 64.4% to 60.2% (P<0.001) during COVID-19 outbreak. After implementation of comprehensive strategies, the DM control from 3Q 2019 to 3Q 2020 was significantly improved. The percentage of patients achieved target HbA1c less than 7% increased from 60.2% to 68.2% (P<0.001).
With the implementation of comprehensive strategies, the DM service was successfully transitioned from conventional care to a New Normal model in COVID-19 pandemic. DM control among our patients in the New Normal era was even better than the period before COVID-19 pandemic.
