Page 193 - HA Convention 2016 [Full Version]

Masterclasses HOSPITAL AUTHORITY CONVENTION 2016

M14.2 Community Care 13:15 Convention Hall C

From Telemonitoring to Self-empowerment
Choo KL
Medicine, North District Hospital, Hong Kong

Chronic obstructive pulmonary disease (COPD) is characterised by progressive airflow limitation that is worsened by acute
exacerbations of severe breathlessness. These exacerbations not only lead to increased healthcare utilisation but also
significantly reduce the quality of life of COPD patients.

Telemonitoring allows clinicians to monitor patients’ clinical status remotely and respond with advice on management. To
healthcare professionals (HCP), “self-empowerment” means patients hold responsible for their own health and lifestyle
choices. Usually the emphasis is placed on designing structured patient education programmes to support “patient
preparedness” to self-management.

How receptive would patients be to telemonitoring? A proto-professional taking measurement such as pulse oximetry and
even interpretation on their own oxygen saturation? This is what Schermer1 referred to as “compliant self-management”. Or
will telemonitoring provide patients with the knowledge and autonomy to decide how they could lead their daily lives? This
ideal form of “concordant self-management” would require the participation of highly engaged patients and HCP.1

Tension between enhancing patients’ self-management ability and HCP’s burden and responsibility to respond to
telemonitoring data was addressed by TELESCOT researchers.2 Patients, however, found access to clinical data about
their condition beneficial. Those who usually delayed medical consultations until they became sufficiently ill to justify an
appointment appreciated the accessibility of telemonitoring service. Telemonitoring data helped to validate their decision to
self-medicate and/or contact HCP. Some learned their own oxygen saturation trends and used real time readings to pace
daily physical activities. For “frequent flyers”, having access to stable objective data was highly reassuring. There was no
longer any need to rush off to hospital or be anxious about their breathing difficulties.3

In our search for personalised medicine, technology can be used to transform our healthcare delivery approach.

References:

1. Schermer M. Telecare and self-management: opportunity to change the paradigm? J Med Ethics 2009;35:688 – 91.

2. Fairbrother P at al. Exploring telemonitoring and self-management by patients with chronic obstructive pulmonary disease:
A qualitative study embedded in a randomized controlled trial. Patient Education and Counseling 2013; 93:403 – 410

3. De San Miguel K, Smith J and Lewin G. Telehealth Research Across the Community – Remote monitoring of Chronic
Obstructive Pulmonary Disease. Strategic Research Series Number 023. Silver Chain. September 2010.

M14.3 Community Care 13:15 Convention Hall C Wednesday, 4 May

Geriatric Rehabilitation Services in Singapore: Its Trade-Offs, Effectiveness, Cost-utility and Barriers to Access
Koh G
Saw Swee Hock School of Public Health, National University of Singapore, Singapore

Singapore has conducted several health services research studies on rehabilitation in inpatient geriatric rehabilitation
hospitals and post-discharge rehabilitation in the community. For example, a retrospective cohort study on all admissions into
all community hospitals in Singapore from 1995 to 2005 (n=19,500), and a mixed methods study on the barriers to adherence
to rehabilitation among elderly patients after discharge from community hospitals (n=70) from 2009 to 2010 were conducted.
A cohort of 200 stroke patients one year after discharge from two community hospitals from 2003 to 2005 in collaboration
with the National University of Singapore Gerontology Research Programme was also followed up. A Singapore Stroke Study
(S3) was completed, which was a community-based follow-up cohort study on health, functional, social and financial effects
of stroke on survivors and their caregivers (including foreign domestic workers) in the first post-stroke year, (n=700) at five
time points (admission, 3, 6, 9 and 12 months after stroke).

Based the results of the studies, key findings will be presented including trade-off relationships between rehabilitation
effectiveness and efficiency with respect to admission functional status and length of stay in stroke and geriatric
rehabilitation; the national performance of Singapore inpatient geriatric hospital rehabilitation effectiveness and efficiency
from 1996 to 2005; the effect of post-discharge community-based stroke rehabilitation on functional recovery; the cost-
utility of adherence to stroke rehabilitation; and physical, social and financial barriers limit patients’ access to community
rehabilitation after discharge.

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