Authors (including presenting author) :
KO WN (1), WAN LM (1), Chan YLD (1), LAU WLC (1), CHIU YY (1), CHEUNG TL (1), LING SO (2), Kwan HY (2), NG PK (2), LING WP (2)
Affiliation :
(1) Occupational Therapy Department of Kowloon Hospital
(2) Respiratory Medical Department of Kowloon Hospital
Introduction :
The Occupational Therapy (OT) out-patient department (OPD) of Kowloon Hospital (KH) has been providing home oxygen therapy (HOT) follow-up (FU) service to patients with chronic respiratory conditions. During the outbreak of COVID-19, face-to-face consultations in clinical settings were deferred, which led to potential delayed patient monitoring and treatment. In view of this, Hospital Authority (2020) released an operation guideline to provide reference to allied health professionals for the implementation of Tele-care under the new normal. Based on this guideline, the Tele-Home Oxygen Therapy Follow Up (Tele-HOT FU) service was started in 2020 to address the service needs of patients receiving HOT. In addition to face-to-face consultations, tele-care interventions were delivered to these patients and their caregivers through HA GO, Smart Patient Website, telephone, email and social media application.
Objectives :
1) To review the Tele-HOT FU service;
2) To explore patients’ and caregivers’ satisfaction and acceptance of Tele-HOT FU service.
Methodology :
Patients referred to KH OT OPD for HOT FU from 1 May 2020 to 30 Nov 2021 were included in the review. Allied health documentation of OT progress notes and discharged summaries were retrieved from CMS for analysis. Patients and caregivers who received Tele-HOT FU were surveyed about their satisfaction and acceptance of the service.
Result & Outcome :
A total of 75 patients were recruited within the review period. 55 (73 %) were male and the mean age was 75.6. Majority of the patients (73%) were diagnosed with Chronic Obstructive Lung Disease. 83% of them were under FU of Specialist Out-Patient Clinic (SOPC) of Respiratory Medicine Department (RMD) in KH. 31 (41%) patients received face-to-face service only, while 44 (59%) patients received Tele-HOT FU service in addition to face-to-face sessions. The patients under Tele-HOT FU received 1.8 Tele-care sessions on average. Each session lasted around 30 minutes. 75% of the Tele-HOT FU sessions were delivered to patients, whereas 25% were to the caregivers. The interventions provided through Tele-HOT FU include: 1) HOT compliance reinforcement (n=41, 93%); 2) ADL coaching and coping strategy education (n=40, 91%); 3) HOT equipment monitoring (n=17, 39%); 4) FU of overnight oximetry reports (n=16, 36%); 5) Home program prescriptions through HA Go (n=9, 20%); and 6) Funding support (n=8, 18%). Both groups of patients showed improvement in indoor (Face-to-face: 58% to 63%, Tele-HOT: 54% to 61%) and outdoor HOT compliance (Face-to-face: 44% to 45%, Tele-HOT: 38% to 43%). 4 patients reported early exacerbation signs during Tele-HOT consultations and all of them prevented hospitalization after liaison with RMD SOPD for advancing medical appointments. 52% of service users welcomed Tele-HOT FU service for interventions that do not require face-to-face consultation. 51% were willing to pay for Tele-HOT FU in the future. The overall satisfaction towards Tele-HOT FU services was 8 out of 10.
Conclusion:
The review of this pilot Tele-HOT FU service provided us service directions on Tele-care for patients receiving HOT under the new normal. Tele-HOT FU allowed occupational therapists to provide timely monitoring and support to patients and caregivers who deferred face-to-face appointments. It also helped frail patients to reduce the risk of exhaustion from transportation to the OPD clinic. However, face-to-face FU remains the main interface for essential interventions involving functional assessment, O2 flow rate titration and education on usage of new Home O2 device. In the future, enhancement on the Tele-care content in HA Go and Smart Patient Website with disease-specific training materials for chronic lung diseases is recommended. Also, further collaboration with RMD SOPC to enhance early symptoms monitoring and reduce avoidable hospital readmission is suggested.
