Authors (including presenting author) :
Loong CHN (1), Lui DTW (2), Wong KCK (1), Lee ACH (1), Tan KCB (2), Woo YC (1)
Affiliation :
1 Department of Medicine, Queen Mary Hospital 2 Department of Medicine, The University of Hong Kong
Introduction :
The congested waiting area of specialist out-patient clinic (SOPC) is a potential high-risk area for cross infection during the COVID-19 pandemic. Alternative intervention is necessary to provide good standard of care. Telephone Consultation by Nurse (TCN) has been identified as an effective remote method in clinical setting.
Objectives :
1) To enhance service quality and continuity of care for patients with osteoporosis during the COVID-19 pandemic 2) To evaluate the effectiveness of TCN
Methodology :
TCN was implemented in osteoporosis clinic in Queen Mary Hospital. This was supervised by endocrinologists in Queen Mary Hospital. Patients who requested to postpone follow-up were assessed by a trained specialty nurse according to a pre-defined protocol. These patients were called by the nurse to provide education on self-management of osteoporosis including fall prevention, life-style modification, awareness of prodromal symptoms of side-effects of anti-osteoporotic agents (including osteonecrosis of jaw and atypical femoral fracture) and ensuring drug compliance. Their clinical progress was reviewed. They were also advised to make phone enquiries in case of changes in medical conditions before their next scheduled clinic visit. Earlier clinic visit would be arranged if necessary. All cases were reviewed with the physician-in-charge in case conference. To evaluate the effectiveness of TCN, an age- and sex- matched control group of patients who physically attended the osteoporosis clinic in the same period was included. All patients in the control group were given nurse education after doctors' consultations. The rates of new fracture, fall, default clinic follow-up and drug compliance were compared.
Result & Outcome :
From 13 February to 15 September 2020, 111 patients requested postpone follow-up (mean age was 82±9 years, 98.1% female). In the study group, 46.8%, 44.1%, 6.3%, 2.7% of patients were receiving denosumab, bisphosphonate, teriparatide, and raloxifene, compared to 55.9%, 37.8%, 3.6%, 2.7% in the control group respectively. The proportion of the treatment regimens in the two groups was comparable. 57 (51.4%) study patients were triaged to osteoporosis nurse clinic for education and monitor drug compliance within eight weeks. All study patients' clinic appointments were postponed. Patients in the study group had a longer duration of follow-up when compared with the control group (34±6 vs. 26±2weeks, p<0.001). After an observation period of 21±2 weeks, both study and control groups had reported similar rates of fall (1.0% vs. 1.0%; p=0.75) and default clinic follow-up (1.0% vs. 2.7%; p=0.62). Both groups reported good drug compliance. Furthermore, there was no new clinical fracture and no patient required early medical attention due to change in medical condition. During the COVID-19 pandemic, special arrangements need to be implemented to minimise the risk of cross infection and ensure unterrupted service delivery to patients. Through patient empowerment by a nurse-led education service via telephone consultations, the high-quality clinical service to patients with osteoporosis can be maintained.
