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An Elder Friendly Environment - Bridging the Gaps in Service Provision

An Elder Friendly Environment - Bridging the Gaps in Service Provision. Dr H Fung Oct 2008. Elderly Service Providers in HK. Hospital Authority Department of Health Social Welfare Department Non-Government Organizations Private sector.

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An Elder Friendly Environment - Bridging the Gaps in Service Provision

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  1. An Elder Friendly Environment- Bridging the Gaps in Service Provision Dr H Fung Oct 2008

  2. Elderly Service Providers in HK • Hospital Authority • Department of Health • Social Welfare Department • Non-Government Organizations • Private sector

  3. Declaration of Alma-Ata 1978 World Health Organization Health, which is a state of complete physical, mental [psychological] and social wellbeing, and not merely the absence of disease or infirmity

  4. Health Needs of Elderly Networking with the various providers Psychological Physical Social Best Outcome Biopsychosocial Model (Engel, 1980) Textbook of Family Medicine, McWhinney

  5. Population Statistics in NTEC, 2007 Total population in NTEC: 1,261,621

  6. NTEC Elderly Population • 130,000 >65yrs old Entire NTEC

  7. NTEC service utilization 2007 IP/DP population SOPC population AED population GOPC population 40% elderly 25% elderly 26-29% elderly 29% elderly

  8. NTEC Service Coverage Entire NTEC • 130,000 >65yrs old IP/DP GOPC SOPC AED 106,502 (82%)

  9. Utilization of Services(Elderly: 130,000) • HA patients: 106,502 (82%) • GOPC: 57,108 (44%) • SOPC: 71,625 (55%) • AED: 46,857 (36%) • IP/DP: 32,145 (25%)

  10. Overlapping of Services(Elderly: 130,000) • GOPC+SOPC: 29,565 (~52% of GOPC patients also attend SOPC) • GOPC+AED: 20,745 (~40% of GOPC patients also attend AED) • SOPC+AED: 30,498 (~40% of SOPC patients also attend AED) • GOPC+Adm: 13,315 (~20% of GOPC patients need admission) • SOPC+Adm: 25,783 (~36% of SOPC patients need admission) • GOPC+SOPC+AED+IP/DP: 9,220

  11. Proposition 1 : Our gaps in services lie in the overlaps

  12. Reasons for GOPC Attendance

  13. GOPC patients attending AED & Admission after AED

  14. GOPC patients: Reasons for AED Attendance

  15. GOPC patients: Reasons for AED Admission

  16. Proposition 2 : Primary care problems are inadequately addressed

  17. IP/DP, AED, SOPD Services NTEC, 2007

  18. Top 10 diagnoses of geriatric patients with hospital admission, NTEC, 2007

  19. Community Care ServicesNTEC, 2007

  20. Bridging the Gaps: Existing Model • Support to OAH and elderly centres: • GOPC reserved quota • Phone consultation • Video consultation • After hour’s home visit • VMOs Caring in the community

  21. Proposition 3 : Scope of community support is too limited to be effective

  22. Bridging the Gaps: Re-thinking Primary Care

  23. Primary care is not for gate-keeping. It’s for HEALTH!

  24. Home Enriching Primary Care Doctor GP Public Hospital System Nurse AH Volunteer NGO Health Resource Centre Telephone Hotline, E Health, Consumer Health Patient Flow

  25. Primary and Community Health Centre Primary Care Out-patient Section • Step-down clinic • Family Medicine triage clinic • Day treatment • Community outreaching services team • Community assessment service • Allied health clinic services • Nurse-led clinic services • Training facilities

  26. Primary and Community Health Centre Community Health Section • Day rehabilitation services • Day psychiatry rehabilitation services • Health resources centre • information enquiry, telephone hotline, nursing consultation, social service support, health promotion programmes, rehabilitation shop, physical fitness and recreation • NGO hub • Mental health promotion • Different from existing HA Day Hospital Services

  27. A Centre for Health Navigation!

  28. Bridging the Gaps: Engaging the Private Sector

  29. NTE Primary Care Coordinating Committee (PCCC) 2007

  30. Objectives • to promote population health in NTEC • to enhance the role of primary care in the overall management of patients • to enhance collaboration between private doctors and public hospitals for the continuity and improvement of patients management and care • to launch health promotion programmes and promote healthy behaviour and lifestyle of the public

  31. Membership

  32. Working Groups • Referrals • IT and Communication • PPI Projects

  33. Programmes on Referrals • Triage Guideline for Medical Cases • HKMA District Based Doctor Lists • Promotion of Family Doctors through Appointment Slips • Setting Up Information Centre at SOPC of AHNH

  34. PPI Projects • Promotion of PPIS – Shared DM Care Programme • Yao Chung Kit DM assessment centre • ePR enrolment

  35. Programmes on IT and Communication • Website/Newsletter • GP information Booklets to Schools • GP information Posters at GOPCs, SOPCs, AEDs

  36. Local Initiatives: • Urology: training for GPs, donation of silicone foleys • Substance abuse among adolescents • One School One GP • Mental health liaison

  37. Sample

  38. Bridging the Gaps: Creating Choice

  39. NTEC PCCC Website “NTE Health Choices” a. Open field b. Restricted field

  40. NTE Health Choices (Open Field)

  41. NTE Health Choices – GP List

  42. GP List links to HKMA Doctors Homepage

  43. Caring for Yourself

  44. NGO & Patient Group Link

  45. Dr. Members Zone (Restricted Field)

  46. Conclusion • Enlarging the caring community • Enriching diversity of services • Engaging everybody • Empowering the elders

  47. Creating an elder friendly environment

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