Page 114 - Hospital Authority Convention 2017

Parallel Sessions
HOSPITAL AUTHORITY CONVENTION 2017

PS3.1 Nurse Clinic 14:30 Room 221

Chemotherapy Nurse Clinic in Contributing the Clinical Pathway for Managing Post-treatment Complications
with Improved Outcome
Liu TK
Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong

Chemotherapy is a major cancer treatment and is mainly delivered in ambulatory setting. But various significant and
predictable treatment related side effects are common, and most of them occur between treatment cycles. Patient needs to
manage the toxicities and symptoms at home that can directly affect patient’s quality of life, tolerance of treatment, treatment
decision or even treatment outcome. Therefore, effective toxicity assessment and prompt symptom management are
important. Nurse-led chemotherapy review has been reported benefits such as increased capacity and reduced waiting time
etc.

From UK experience, nurse-led chemotherapy review had been shown to be as effective as doctor-led chemotherapy review
in various therapeutic areas but there is no “golden model” for establishment of the service. It can be designed for specific
disease or chemotherapy agent, with or without on-site oncologist support, accessible or not to non-medical prescribing,
which depends on the local arrangement.
In Hong Kong, non-medical prescribing is not adopted due to legal and regulation policy, and the role of registerable
advanced nurse practitioner is not yet established. Despite those limitations, nurse-led chemotherapy review clinic is the
Tuesday, 16 May chemotherapy nurse clinic focusing on treatment-induced toxicity grading, assessment and the related management is
priority of development across six oncology centres. Although no one model fits all chemotherapy nurse clinic, there are
certain universal principles. Nurses should not duplicate the medical model or provide stand-alone service. Hence, the
appropriate for our local setting. This model has been adopted in the oncology centre of the Prince of Wales Hospital that
first target the group of head and neck patients undergoing concurrent chemoradiotherapy. It aims at adding nursing values
to chemotherapy service by providing holistic care and family support, and performing advanced nursing practice such as
patient examination, including skin status, oral cavity condition and nutritional status, toxicity assessment and management
of symptoms during treatment, making referral to other appropriate healthcare professionals, etc. Improved patient outcome
with less unnecessary hospitalisation, less weight loss, better coping for nutritional problem and psychological support were
demonstrated in a two-year prospective survey. Feedback from the medical colleague was positive because the consultation
time could be shortened and patient-focused concerns can be addressed more effectively.

PS3.2 Nurse Clinic 14:30 Room 221

Effectiveness of Diabetes Nurse-led Clinic in Treating People with Type 2 Diabetes Mellitus
Leung ELY
Department of Medicine, Queen Mary Hospital, Hong Kong

Background
It is estimated that the prevalence of diabetes mellitus (DM) in China would be increased from 98.4 million people in 2013
to 142.7 million by 2035. This rapidly growing prevalence will inevitably put heavy burden to the healthcare system. Nurse-
led DM management programmes have been proven effective in western countries. However, studies to evaluate nurse-led
DM intervention in Chinese were inadequate. Awareness of cultural sensitivity in those effective nurse-led programmes to
Chinese is important. Therefore, a study was conducted to evaluate the effectiveness of Diabetes Nurse Clinic (DMNC) in
improving glycaemic control of Chinese patients with type 2 DM.

Methodology
It is a 24-week randomised controlled study. 150 Chinese patients with type 2 DM of sub-optimal glycaemic control, i.e. at
HbA1c level between 7.5% and 9.5% were recruited. Patients in the intervention group received Diabetes Self-management
Education (DSME) and protocol driven medication intensification, which were arranged in three bimonthly DMNC visits and
a telephone call one month following each DMNC. Patients in the control group received usual group DM education and
medical care. The primary outcome was measured in haemoglobin A1c (HbA1c) level.

Results
The mean age of the 150 patients was 63.6 + 9.7 years, with a mean duration of DM of 13.7 + 8.5 years. At baseline,
the 75 patients in the intervention group and 75 patients in the control group had no significant differences in all clinical
characteristics. At 24 weeks, patients under the management in the DMNC had the HbA1c level significantly reduced by 0.7%
(95% CI = 0.4% to 1.0%, p < 0.001) more than those under usual care. The corresponding reductions in the intervention and
control groups were 1.0% (95% CI = 0.8 to 1.2, p < 0.001) and 0.3% (95% CI = 0.1 to 0.6, p=0.002), respectively.

Conclusions
This study provided evidence to support that DMNC could improve glycaemic control of Chinese patients with type 2 DM of
sub-optimal glycaemic control. DMNC is a routine medical care is therefore recommended for Chinese patients with type 2
DM.
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