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

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

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

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

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

10. 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%)

11. 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

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

13. Reasons for GOPC Attendance

14. GOPC patients attending AED & Admission after AED

15. GOPC patients: Reasons for AED Attendance

16. GOPC patients: Reasons for AED Admission

17. Proposition 2 : Primary care problems are inadequately addressed

18. IP/DP, AED, SOPD Services NTEC, 2007 All ages episodes 65+ episodes 65+ headcounts 65+ episodes/ headcounts IP/DP 195,043 (100%) 77,422 (40%) 32,1452.4 AED 390,490 (100%) 96,660 (25%) 46,8572.1 SOPD 922,451 (100%) 265,709 (29%) 71,6253.7

19. Top 10 diagnoses of geriatric patients with hospital admission, NTEC, 2007 No. of IP/DP episodes No. of IP/DP headcounts Ratio of episodes/ headcount % of total IP/DP episodes(>6 5y.o) Malignant neoplasm 60202663 2.38% COPD 47532007 2.46% CRF 4725475 9.96% Pneumonia 44363174 1.46% Heart failure 22941365 1.73% IHD 17081232 1.42% Fracture hip 1436919 1.62% DM 12711145 1.12% Gall bladder disease 945655 1.41% CVA 554395 1.41%

20. Community Care Services NTEC, 2007 No. of CNS visits for 65+ aged86,160 No. of geriatric outreach attendances 71,133 No. of geriatric day attendances24,771 No of Visiting Medical Officer attendances 21,999 No. of Psychogeriatric outreach attendances 7,971

21. 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

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

23. Bridging the Gaps: Re-thinking Primary Care

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

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

26. 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

27. 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

28. A Centre for Health Navigation!

29. Bridging the Gaps: Engaging the Private Sector

30. NTE Primary Care Coordinating Committee (PCCC) 2007

31. 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

32. Membership Advisors:Dr. FUNG Hong Dr. CHOW Chung Kwan Co-Chairmen:Prof. Philip LI Dr. Kelvin Siu Wan WU Members:Dr. Nancy TUNG(Rep. from NTEC and Hospitals) Dr. Augustine LAM(Rep. from NTEC and Hospitals) Dr. MAK Wing Kin(Rep. from HKMA Shatin Community Network) Dr. CHIU Sik Ho(Rep. from HKMA Taipo Community Network) Dr. LEE Chok Huen(Rep. from HKMA Taipo Community Network) Dr. CHAN Kin Hing(Rep. from HKMA Taipo Community Network) Dr. LI Shan HO(Rep. from HKMA Taipo Community Network) Dr. Thomas SZ(Rep. from GPs in North District) Sponsors:NTEC HKMA Taipo Community Network

33. Working Groups Referrals IT and Communication PPI Projects

34. Programmes on Referrals 1.Triage Guideline for Medical Cases 2.HKMA District Based Doctor Lists 3.Promotion of Family Doctors through Appointment Slips 4.Setting Up Information Centre at SOPC of AHNH

35. PPI Projects 1.Promotion of PPIS – Shared DM Care Programme 2.Yao Chung Kit DM assessment centre 3.ePR enrolment

36. Programmes on IT and Communication 1.Website/Newsletter 2.GP information Booklets to Schools 3.GP information Posters at GOPCs, SOPCs, AEDs

37. Local Initiatives: 1.Urology: training for GPs, donation of silicone foleys 2.Substance abuse among adolescents 3.One School One GP 4.Mental health liaison

41. Bridging the Gaps: Creating Choice

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

43. NTE Health Choices (Open Field)

44. NTE Health Choices – GP List

45. GP List links to HKMA Doctors Homepage

46. Caring for Yourself

47. NGO & Patient Group Link

48. Dr. Members Zone (Restricted Field)

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

50. Creating an elder friendly environment