Page 119 - Hospital Authority Convention 2018

Service Enhancement Presentations

F1.6 Better Manage Growing Demands 10:45 Room 421

New Service Model of Osteoarthritic Knee Management in GOPC setting – Conjoint Osteoarthritic Knee
Programme with Physiotherapist and Doctor
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Ng COY ,2, Cheung KL , Lam YY , Pon WP , Cheng WF , Luk W , Chan C , Chiu YC , Fung YH , Kwok ML 2
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1 Family Medicine and Primary Health Care Department, Kowloon West Cluster, Hospital Authority, Physiotherapy Department, HOSPITAL AUTHORITY CONVENTION 2018
Caritas Medical Center, Hong Kong
Introduction
Enhanced Public and Primary Services (EPPS) with Allied Health Physiotherapy (PT) at West Kowloon General Outpatient
Clinic (WKGOPC) was set up since 2013. Until October 2016, 5,385 GOPC patients were referred to WKGOPC PT. 3,918
patients (72%) were screened with chronic musculoskeletal (MSK) problems and being treated under one-patient-one-
physiotherapist service model. Among patients with various musculoskeletal concerns, 1,101 patients (28%) were diagnosed
with osteoarthritic knee (OA knee) or knee pain. In August 2016, waiting time for MSK routine cases had been increased to
26.1 weeks. In order to shorten the long waiting time and meet the growing needs of chronic MSK patient group under limited
manpower resources (One PT at WKGOPC), conjoint OA knee programme with GOPC PT and doctor was started in October
2016. Under a newly developed collaborative management program, it is believed that unduly long GOPC PT waiting time
could be alleviated. Patients’ expectation on their best understanding of the chronic disease and long term self-management
skills could also be achieved.
Objectives
(1) To set up a new service model to shorten patients’ waiting time to receive PT services; (2) to deliver a cost effective and
efficient collaborative OA knee program in GOPC setting; (3) to treat and empower OA knee patients with respect to their
appropriate level of care.
Methodology Monday, 7 May 2018
Patients with non-acute knee symptom(s) and being diagnosed with OA knee (confirmed by X-ray finding) were referred by
doctors from five different GOPCs in Sham Shui Po district. Firstly, patients were grouped to attend a one-hour conjoint OA
knee class at WKGOPC (class size: 60), in which a GOPC doctor explained to patients on etiology, pharmacological and
orthopedic management of degenerative knee; whereas PT educated patients on practical tips for symptom-control, home
exercises and self-care techniques. Secondly, all patients were arranged to attend individual PT follow-up (FU) session (within
six weeks after the conjoint knee class) for assessment, treatment and monitoring of knee conditions. In PT FU session,
patients would be discharged if knee conditions improved, or with good exercise compliance and self-management skills.
Patients could be referred back to consult GOPC doctor by PT if being screened with red flag sign or other comorbidity.

Results
Seven sessions of conjoint OA knee class are arranged from October 2016 to October 2017. 199 OA knee patients are
referred (Mean age = 64±9.9 years; Male 52, Female 147). Retrospective cohort reviews that overall GOPC PT waiting time
of MSK routine cases at WKGOPC is sustainably decreased after implementation of the conjoint knee class (Median waiting
time: 22.4 ± 3.5 weeks versus 14.5 ± 5.0 weeks). Waiting time for OA knee patients to receive GOPC PT service is drastically
decreased to 4.7 ± 1.3 weeks. Attendance rate of subsequent PT FU sessions are improved; that is, 72% versus 75%.
Number of the PT FU sessions is decreased (3 versus 2 sessions). Every patient completes a KAP survey after finishing
conjoint OA knee class. This is used to evaluate their knowledge of self-management skills, attitudes towards joint care
advice and practices of behavioral change. Consistently high scores are secured (93%; 99% and 99% respectively). A patient
satisfaction survey is done and the overall patient satisfaction scores 5.33 out of 6. Mean of patient satisfaction in three
components; namely program content, organization and patient engagement, are 5.35; 5.26 and 5.38 respectively. Results
imply that there are consistently high patient satisfactions on conjoint OA knee class.
Conclusion
To conclude, not only this new OA knee management model shortens waiting time for patients receiving GOPC PT services;
but providing an interactive patient-physiotherapist-doctor platform for patients’ best understanding and self-management of
chronic degenerative disease. Good clinical outcomes also demonstrate that this service model is efficient and cost effective
in primary care setting.

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