Parallel Session 4 – Brining Innovation to Allied Health Practice

The COVID-19 pandemic outbreak in 2020 has posed a serious challenge to the worldwide healthcare system. To focus the manpower and resources in providing essential and inpatient services, adjustment of services has been made in Hospital Authority. Yet, every crisis calls for a motivation to innovate and develop new initiative; crisis always means opportunity. It is with this underpinning that Telehealth model was developed under Allied Health Grade to maintain patient's access to our services, enabling us to take care of the psychological well-being of our patients despite the strict adherence to the social distancing requirements at the peak of the pandemic. The pandemic crisis has cultivated general population's acceptance and development of knowledge in using digital platforms. It has fostered smart access to HA services, which is epitomized by the launching of the mobile app of HA GO in December 2019. In line with HA's direction, protocol-driven structured programs (stress/relaxation, insomnia, parenting) and cognitive rehabilitation training programs have been developed. With the gradual upgrading of HA GO's functions, e.g. HA GO Payment services, more patients can benefit from this easily accessible, efficient and quality-assured service. Since 2020, over 20 Telehealth groups under structured programs have already been delivered in KWC clinical psychology service. In this presentation, the experience of KWC clinical psychology service on Telehealth will be shared. The first-person perspective of a patient will be used to walk us through a patient's journey in receiving Telehealth clinical psychology service.

Introduction:
During the COVID-19 pandemic, the social distancing policy and restricted hospital visits have resulted in significant caregiver burden. This is the result of carer's uncertainty of the patients' health status and also lack of awareness of transitional and community care services upon discharge. In view of the unmet care needs and lacking community service provisions amidst the pandemic, we developed the Early Discharge Support Program (EDS) to strengthen the communication with clinical teams and to facilitate the accessibility of social services through community partnership and telecare.  


Program Objectives:
It aimed to facilitate the smooth transition of care, reduce caregivers' distress and decrease patients' length of stay in hospital.         


Methodology:
Patients who were admitted to the medical stroke or neurosurgical wards of Queen Mary Hospital and their core family members were recruited to join the EDS program from Aug 2021 to Dec 2022. Clinical teams identified specific patients requiring support to join a new online patient orientation program in which caregivers could communicate with clinical staff on disease management and engage with multi-dimensional community support services by online platform. Tele-visit of hospitalized patients and virtual visits of community services were arranged for patients in need and their caregivers. These measures allowed caregivers to gain a better understanding of patients' health conditions and increased awareness of concrete social service provisions in the community. With these supportive measures, the caregivers became more confident in handling discharge arrangements. Quasi-experiment with non-equivalent control group design was adopted. Participants were invited to complete an online questionnaire upon patient admission and one week after patient discharge. Caregiver's distress was measured by the validated Cantonese short version of the Zarit Burden Interview (C-ZBI) and Patient Health Questionnaire - 2 (PHQ-2) respectively. The length of stay of the experimental group and control group was compared.     


Results and Outcomes
421 caregivers were recruited during the data collection period. The mean C-ZBI score, reflecting caregiver distress, reduced from 9.37 to 7.44 (p<.0001). The mean PHQ-2 score also dropped from 2.07 to 1.28 (p<0.0001). There were statistically significant reductions in caregiver's distress level. The length of stay of specific patient group was shortened by 13 % and 12.4 % in the medical stroke and neurosurgical wards respectively.


Conclusion:
The program enlightened us on the use of telecare service to support patients and their caregivers on the arrangement of care during transition from hospital to community. By empowering caregivers to be active care masters, they could make good use of online and self-financing community services to facilitate the transition care arrangement efficiently. The discharge planning process could be accelerated through early matching of care needs to appropriate community services. Undoubtedly, the structured telecare workflow, cross-discipline collaboration and shared care with community partners led to the successful implementation of the program.

Background:
Facing the problems of ageing population, knee osteoarthritis (OA) will generate more and more impact on the health care system. The median waiting time for total joint replacement (TJR) surgery among hospitals in 7 clusters of Hospital Authority (HA) in 2020 ranged from 16 to 28 months, which has risen to 27 to 56 months in 2022. The increasing waiting time indicates a need for an innovative approach for management of this group of patients. Growing international experiences suggested structured progressive exercise regime and self-management program as effective conservative management for knee OA (1,2).


New Care model of Structured Non-surgical Treatment Program (SNTP):
A four-year physiotherapy program was first launched in June 2020 in Yan Chai Hospital, Kowloon West Cluster to deliver holistic education, exercise empowerment and longer follow-up period to knee OA patients who were on the TJR waitlist. The program was extended to other 6 Clusters later from 2021 to 2022. It aimed to provide regular monitoring, reporting of symptoms and physical function to orthopedic team, pre-habilitation concept by case management approach for better post-operation outcomes and optimizing physical functions of the patients. The program started with the induction phase in the first year including 4-6 sessions of out-patient physiotherapy led by a physiotherapy case manager, and then followed by the maintenance phase from the second to fourth year with 2 booster sessions per year. Tele-care refresher class in-between booster sessions were introduced to patients in need. The course content covers introduction to disease progress of knee OA, therapeutic exercise, motivation and behavioral modification, coping strategy and self-management techniques and weight management advice. A wide spectrum of different service modes was adopted such as individual assessment and treatment, group exercise and sharing class, education talk, hydrotherapy class and tele-care session. Close communication among the case manager, the patient and the orthopedic specialist facilitate the timely clinical decision likes advancing, postponing or even withdrawal from the surgery because of the improvement after the self-management approach. For the stable patients, they can be referred for maintenance program with District Health Centre (DHC).


The preliminary evaluation of the SNTP patients in the first and second year of follow-up showed positive outcomes in decreasing pain and disability level and improving physical function. SNTP demonstrates promising effects for the OA knee patients on the TJR waitlist in preventing the deterioration of their clinical conditions and hence minimizing the need for surgery.

Smart care and innovation rehabilitation are emerging fields within Occupational Therapy (OT) that are focused on leveraging technology to improve the quality of care and outcomes for patients. It involves the use of technologies and tools to enhance the assessment, treatment, and monitoring of patients. This includes wearable devices, mobile applications, telehealth services, robotics, 3D-printing application and virtual reality (VR), among others, to support patients in regaining function and independence.
 
One of the most common advance technologies that is increasingly being used in OT is VR. VR technology allows patients to participate in simulated environments that mimic real-life situations, which can be used to address physical and cognitive challenges. For instance, VR is used to simulate real-life scenarios, such as cooking, crossing the street or navigating public transportation, to help patients with cognitive problems to improve their safety awareness and reduce risk in daily livings. Another application of advance technologies is 3D printing in fabrication of hand splinting, training tools and customized assistive devices. Traditionally, these devices are mass-produced and may not fit individual needs. With 3D printing technology, therapists can create assistive devices or modify existing equipment that are tailored to the patients, leading to a more personalized care and better quality of life. Lastly, tele-health has also become increasingly popular since COVID-19 pandemic. Through the HA GO prescription, it facilitates tele-rehabilitation and education remotely, by adopting protocol-driven telecare service. Other telehealth platform is piloted to deliver tele-consultation and assessment, provide access to therapy training and instructional materials, as well as monitor patients' progress.
 
Together, smart care and innovation rehabilitation are transforming the field of OT and offering new tools and strategies for improving patient outcomes. By leveraging technology, occupational therapists can deliver more personalized and effective care to patients, while also improving the efficiency and effectiveness of clinical practice.