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Better Control of NCDs through Patient
Empowerment in Primary Care in Hong
Kong - A Case Study
Peter POON
Deputy CEO, HKSR
30 October, 2014
The 6th Global Conference of the Alliance for Health Cities
This presentation covers
Problems of NCDs
Innovative Care Model’s
What is “Empowerment”?
Patient Empowerment in CRN
Studies and findings about PEP
Transformation of CRN through e2Care
Conclusion
Problems at different levels of Healthcare
Micro
Level
• Empower Patients and Families
• Value Patient Interactions
Meso
Level
• Organize care
• Tools and expertise of providers
• Evidence-based practice
• Prevention
• Information systems
• Connection with community
resources
Macro
Level
• Legislative framework
• Health policies and plans
• Investing wisely and financing
• Provider incentives
• Standards and monitoring
• Continuing educations
• Inter-sectoral links
Innovative Care for Chronic Conditions (WHO)
A New Patient Management System Multidisciplinary patient management system (education, system navigation, follow-up, disease
management including medication management) decreases hospital admission by 50%.
Complex
Well
Chronic stable
Chronic unstable
Well at risk
Prevention and Promotion
Secondary Prevention
Treatment
Case Management 10%
Shared Management 20%
Self Management 70%
National Health Services Case Management Model, UK
What is Empowerment ?
The process of increasing the capacity of individuals or
groups to make CHOICES and to transform those choices
into desired actions and outcomes (World Bank);
Happens when individuals or groups of people recognize
that they alone can CHANGE their situation and then
begin to do so;
People with disabilities and their families TAKE
RESPONSIBILITIES for their development within the
context of general community development;
Self-Help Groups, Disabled Peoples
Groups/Organizations (DPOs), Parents Groups are the
PILLARS OF EMPOWERMENT.
7
Power Resources (Overcoming Powerlessness, Judith Fitzgerald Miller)
1. Physical Strength
2. Psychologic Stamina – Social Support
3. Positive Self-Concept
4. Energy
5. Knowledge and Insight
6. Motivation
5. Belief System
Community Rehabilitation Network
Set up in 1994 by the Hong Kong Society for
Rehabilitation as a pilot project (1994-1997)
Aims to support and empower people with disabilities
and chronic conditions in the community
Funding support from government, charities and projects
Now have 6 service centers throughout the territories of
Hong Kong
Around 100 staff (include projects) – 60 social workers,
10 healthcare professionals, 30 program and supporting
staff
Lots of volunteers – corporate, professionals, lay and
peers (PwD and Chronic Conditions)
STRATEGIES OF CRN
Individual
empowerment
Collective
Empowerment
Self- → Self- → Self-help → Advocacy
acceptance management Mutual aid Public awareness
Empowering people with disability to live a fulfilling life
Page 11 © 2004 Hong Kong Society for Rehabilitation. All rights reserved.
Patient Empowerment Programme
Initially a pilot project starting 2009, commissioned by
Hospital Authority (HA) of Hong Kong
1st Phase (March 2009 – March 2014), 2nd Phase (April
2014 – March 2016)
HKSR currently serving 4 out of 7 of the Hospital
Authority service clusters
Target groups mainly patients living in the community
with Chronic Conditions. Referred by HA Family
Physicians via electronic referral systems at the general
out patients clinics
Page 12 © 2004 Hong Kong Society for Rehabilitation. All rights reserved.
Objectives of PEP
To provide participants a combination of knowledge, skills
and heightened self-awareness regarding their own disease
conditions so that they can use this power to act in their
own self-interest
To promote autonomous self-regulation so that the
participants’potential for health and wellness can be
maximized
At the end of the programme, participants should
understand that they are responsible for their diseases and
have knowledge and ability to manager their own health
PEP Intervention Pathway Patient is referred
for PEP
Patient Profiling
Assessment
Individual
Self-
management
facilitation
Group-based
Empowerment
Program
(Action
learning)
Post-programme
Assessment
Follow-up
and Value Added
Support Services
Pre-programme
Assessment
“A Study on The Quality Enhancement of
the Hong Kong Society for Rehabilitation
based PEP”
An initiative for self improvement
Support by a number of academic experts
who are also the Members of Committee on
Rehabilitation of HKSR
Focus on the participants’ change in self
management behaviors, self efficacy and
other health related factors
Methodology
Pre- and Post- Questionnaire Survey
Two Time-Point Assessment:
First time attend the HKSR-PEP programme
3 months after the first assessment
Target Subject
Type 2 diabetic patients
Be referred to HKSR-PEP by GOPC
Agree to join HKSR-PEP
Willing to join the study (voluntary participation)
Interviewed by trained volunteers and HKSR staff
Major Findings
365 HKSR-PEP participants joined the study
Demographics:
Age: 62.9 +/- 9.6
Male vs. Female: 41.4% vs. 58.6%
Mainly with Primary (36.7%) and Secondary (43.8%)
education
Years of having DM:
<1 year: 43.8%
1 – 5 years: 25.3%
> 5 years: 30.9%
70.4% were diagnosed with others type of chronic
illnesses
Major Findings
Improvement in self management behavior
41% improved Diet Control
53% improved Exercise
54% improved Blood Glucose Testing
51% improved Foot Care
62% improve the Self Efficacy of diabetic self management
62% enhanced the ability to understand and use the Health
Information (Health Literacy)
Higher participation in HKSR-PEP -> Higher improvement in
Diet Control, Blood Glucose Testing, Foot Care, Self
Efficacy
Summary of the CRN PEP Study
PEP
is an effective programme of collaboration between
HA and NGO to tackle the issue of NCDs in primary
care in Hong Kong
demonstrates a successful example of a private-
public partnership service delivery model
is suggested to extend to other health services for
better control of NCDs in Hong Kong
New service delivery model is also suggested to
provide to NCDs patients after PEP to maintain and
further enhance self management behaviors
+
系統分析
建議服務
增加個人
健康紀錄
醫護人員了解
「你」健康狀況
開設戶口
報名
定期更新 / 提供服務資訊
社交網絡
學習進度
健康管理
線上課程
混合教學
課程
線上
互動群組
行為改變
•失語症 社區復康支援中心
•支援基地
•課程設計
•訓練課程
•義工支援
自我管理工具
Apps
e2care 自我管理
支援中心 Self Management
Centre
e2care.hk
CRN
+
自助互助支援
混合復康 溝通治療
5
e2care Project Service
Framework
Conclusion Hugh impact of NCDs and overwhelming problems at all
levels
Patient Empowerment has been an proven effective
strategy and deserves more attention
Services change with time and needs, while the mission
and the journey to empower the patients and their care-
givers will stay
Next generation of patient empowerment interventions in
the form of mixed-mode learning, i.e. interplay between
on-line and off-line experience
“People-centered care” is not a slogan, but something to
be actualized through courage, collective wisdom and
innovations
Empowerment
THANK YOU
