Page 124 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F1.5 Service Revamp 13:15 Room 421

Randomised-controlled Study of the Effectiveness of a New Psychiatric Specialist Outpatient Service Model —

the Multidisciplinary Assessment and Psychosocial Intervention Programme vs Standard Psychiatric Outpatient

Care
Lin W 1, Li SM 2, Leung MC 1, Li CW 5, Chan LF 1, Lo S 3, Au R 3, Mak AD 4, Leung CM 1 , Wing YK 1,4
1Department of Psychiatry, Prince of Wales Hospital and Shatin Hospital, 2Department of Clinical Psychology, Prince of Wales
Hospital, 3Department of Occupational Therapy, United Christian Hospital, 4Department of Psychiatry, The Chinese University of
Hong Kong, 5Department of Psychiatry, United Christian Hospital

Introduction

Lack of discharge pathway and coordinated multidisciplinary care to patients with common mental disorders (CMD, such
as mild to moderate depression and anxiety disorders) at local tertiary psychiatric clinics has led to service congestion,
unsatisfactory outcomes and risks diverting scarce resource from care of high-risk and complex mental illnesses. Based
on bio-psychosocial formulation and multidisciplinary management, the Multidisciplinary Assessment and Psychosocial
Intervention Programme (MAP) consisting of psychiatrists, an advanced practice nurse, a clinical psychologist and an
occupational therapist was delivered to patients with CMD at Li Ka Shing Psychiatric Clinic of Prince of Wales Hospital since
2009.

Tuesday, 3 May Objective
To examine effectiveness of the MAP programme compared to standard care.

Methodology

240 patients diagnosed with CMD by triage clinic were recruited in this study. In a randomised controlled trial, MAP group
(n=120, mean age = 49.5, SD=11.4) was compared with standard care group (n=120, mean age = 47.2, SD=12.3). Data
collection points were at baseline (first clinical intake), three months, six months and twelve months at follow-up, with
treatment outcome measures including change in mean global psychiatric symptom scores (SCL-90R global severity index),
quality of life (SF-36) scores, Clinical Global Impression scale (CGI), Hospital Anxiety and Depression Scale (HADS), and
appraisal of service using Patient Satisfaction Scale (PSS). Chi-square analysis and analyses of variance (ANOVA) were used
to compare baseline characteristics. Repeated measure ANOVA was used for analysing treatment effects on all outcome
variables within and between participants over time. Subgroup analysis was conducted for each outcome measure within
each severity subgroup.

Results

Results indicated that MAP group showed higher level of improvement rated by clinicians (CGI-I, p<0.001), and higher level of
patient satisfaction on services (PSS, p<0.001) compared to the control group, despite that both groups showed statistically
significant improvements on most outcomes by time. Subgroup analyses also showed significant differential improvements
over time by treatment on subscales of SCL-90R including depression (p=0.03), obsessive-compulsive (p=0.04), interpersonal
sensitivity (p=0.02), hostility (p=0.02), and paranoid ideation (p=0.04) among the less severely depressed participants.

ConclusionsOur result has proved that multidisciplinary care in the form of MAP Program, to patients with CMD, may be
better than standard care. Patients assigned to MAP service were more satisfied with the help they received than those
of the control group. Preliminary results also indicate that early intervention with bio-psychosocial and multidisciplinary
management model, especially for depressed patients, is effective for reducing patients’ symptoms.

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