Replies to LegCo questions
LCQ17: Dementia
Following is a question by the Hon Tang Ka-piu and a written reply by the Acting
Secretary for Food and Health, Professor Sophia Chan, in the Legislative Council
today (February 25):
Question:
It is learnt that the number of dementia patients has increased in recent years
amid an ageing population. Following the establishment of the Review Committee
on Mental Health in May 2013, the Government set up an expert group under the
Committee to study the care for dementia patients. In this connection, will the
Government inform this Council:
(1) of the average waiting time for those people who received assessment for
dementia, the number of patients diagnosed with the disease (with a breakdown by
age of the patients and hospital cluster to which their places of residence
belong), as well as the average waiting time for patients who had been diagnosed
with the disease to receive the first treatment, in the past five years;
(2) of the objectives and progress of the work of the aforesaid expert group;
whether the authorities will consider following the practices of the United
Kingdom and Taiwan by formulating specific healthcare policies on dementia; if
they will, of the details; if not, the reasons for that;
(3) whether it knows the non-self-financed drugs currently provided by the
Hospital Authority (HA) for dementia patients (and set out the various
categories of drugs by different degrees of symptoms suffered by the patients);
(4) whether it knows the non-pharmacological treatment services currently
provided by various public hospitals for dementia patients and the relevant
service quotas, and whether it has assessed the effectiveness of such services
(and set out the information by hospital cluster);
(5) whether assessment for dementia is included in the Elderly Health Assessment
Pilot Programme currently provided by elderly health centres; if it is included,
of its effectiveness; if not, the reasons for that, and whether the authorities
will consider including such an assessment in the programme;
(6) whether it will consider launching a public-private partnership programme to
provide medical consultation services for dementia patients; if it will, of the
details and timetable for launching the programme; if not, the reasons for that;
(7) of the efforts made by the authorities in the past five years to strengthen
and integrate the healthcare and social welfare services related to dementia; as
this year's Policy Address has mentioned that the authorities will invite the
Community Care Fund to explore the implementation of a pilot scheme by drawing
on the concept of "collaboration between the welfare and healthcare sectors",
with a view to providing integrated community healthcare and rehabilitation
services in suitable elderly health centres for elderly persons living in the
community and suffering from dementia, of the concrete plans in this regard; and
(8) as the authorities pointed out in its progress report submitted to this
Council in September last year on the motion on "Formulating a comprehensive
elderly care policy to deal with population ageing" that adopting a unified
Chinese equivalent to "dementia" would help promote public understanding on the
disease and that "認知障礙症" would be adopted as the Chinese equivalent to dementia
in all government documents, whether the authorities will consider stepping up
its publicity to keep the public well informed of such a practice; if they will,
of the details; if not, the reasons for that?
Reply:
President,
(1) The Hospital Authority (HA) has put in place a referral and triage system
for its psychiatric specialist out-patient services to ensure that appropriate
support and timely treatment are provided for patients with varying degrees of
illness. New patients are usually first triaged by nurses and reviewed by
specialist doctors for classification into priority 1 (urgent), priority 2
(semi-urgent) and routine cases on the basis of their clinical conditions and
presenting symptoms. The HA's targets are to maintain the median waiting time
for first appointment of priority 1 and 2 cases within two weeks and eight weeks
respectively. This is to ensure that patients with urgent healthcare needs are
given medical attention within a reasonable time. In 2013-14, there were about
11 900 patients with dementia receiving psychiatric specialist services provided
by the HA, and the median waiting time for first appointment of psychogeriatric
service was eight weeks.
(2) Set up in May 2013, the Review Committee on Mental Health is responsible for
reviewing the existing policy on mental health with a view to mapping out the
future direction for development of mental health services in Hong Kong. Two
expert groups were set up under the Review Committee. The group tasked with
studying dementia is reviewing the delivery model of existing care services, and
will make recommendations on ways to enhance long-term care for dementia
patients.
(3) Regarding drug treatment, special drugs for treating dementia (including
Donepezil, Galantamine, Rivastigmine and Memantine) are included in the Hospital
Authority Drug Formulary. Special drugs are prescribed by specialists for
patients who have been assessed as having the specified clinical conditions and
the clinical therapeutic needs. The drugs required will be provided by the HA at
the standard fees and charges. For patients who do not have the specified
clinical conditions but choose to use and are prescribed the special drugs, they
will have to pay for the drugs as self-financed items. Taking the patients' wish
into account, specialists will provide necessary treatments for patients
according to the clinical needs of the patients and the clinical treatment
protocol.
The HA has been taking measures over the years to increase the use of new
anti-dementia drugs with proven clinical efficacy to improve the quality of life
and delay the functional deterioration of dementia patients. The number of
patients using new anti-dementia drugs increased from 6 800 in 2009-2010 to 13
900 in 2013-2014. In 2014-15, the HA allocated an additional funding of $12
million to increase the use of new anti-dementia drugs to benefit more patients
whose clinical conditions allow the use of these drugs. The HA will continue to
keep in view the development of new anti-dementia drugs and review the use of
drugs through the established mechanism.
(4) Through its clusters the HA strives to provide in-patient, specialist
out-patient, day hospital and community outreach services for patients with
dementia. If a patient is suspected to have developed dementia, he/she will be
referred to the relevant specialty of a hospital for assessment. Depending on
the severity of the condition, the medical team will formulate individualised
treatment plans for the patients, provide them with medication, cognitive
training and rehabilitation services, and refer them to suitable social service
agencies for follow-up, according to the need of the patients in each case. The
HA also provides support and training for family members and carers of patients
with dementia through different channels with a view to enhancing their
understanding of dementia and their caring skills.
Elderly patients residing at residential care homes for the elderly (RCHEs) are
supported by the HA's outreach services through its community geriatric
assessment teams and psychogeriatric outreach teams. The service targets cover
elders with dementia. Services provided include formulation of treatment plans,
monitoring of patients' recovery and follow-up consultations. On-site training
will be given to care workers at the RCHEs, if required, to enable them to
master the skills in taking care of dementia inmates. At present, the HA's
community geriatric assessment teams serve about 650 RCHEs, while the
psychogeriatric outreach services cover most subvented RCHEs and over 200
private RCHEs in the territory.
The HA has also made available information relating to dementia, care management
and community resources on its one-stop Smart Patient website, with a Smart
Elders webpage dedicated to strengthening support for high-risk elderly
patients.
(5) The Elderly Health Centres of the Department of Health (DH) serve elderly
people aged 65 or above by providing them with integrated primary healthcare
services, such as health assessment, counselling, medical treatment and health
education. The services of the Elderly Health Centres include assessment and
examination for dementia. The centres adopt internationally recognised
assessment tools suitable for the local elderly to examine their members for any
symptoms of dementia during regular health assessment. The Elderly Health
Centres will provide follow-up services for members or refer cases for follow-up
by HA specialists if necessary. As at September 2014, Elderly Health Centres
identified 1 818 suspected cases of dementia by using the assessment tools,
representing about 6 per cent of the persons receiving health assessment over
the same period.
(6) Before deciding whether to introduce a public-private partnership programme
for a clinical service, the HA will take into account a series of factors,
including service demand, service capacity of the market and service quality,
and patients' clinical conditions and acceptance. Relevant stakeholders
including the specialties and patients concerned will also be widely consulted.
For dementia, the HA will keep the situation in view before considering whether
public-private partnership is applicable to this type of clinical service.
(7) Dementia affects the physical, psychological and cognitive domains of a
patient. For patients with dementia living in the community, they require
support services in different areas and social care in the community is often
more important than medical care.
In view of this, the Administration has been promoting medical-social
collaboration in providing appropriate services for persons with dementia. On
the part of the HA, medical personnel will conduct assessments and arrange
social service referrals for persons with dementia and their families based on
their needs. The HA's community geriatric assessment teams and psychogeriatric
outreach teams provide outreach services for RCHEs to support elders with
dementia and their carers. Besides, medical social services are available in
public hospitals and some specialist out-patient clinics to provide
psychological intervention for patients including persons with dementia. The DH
also collaborates with the Social Welfare Department and non-governmental
organisations to organise dementia seminars, workshops and health talks to give
practical tips on dementia care. The Administration will continue to explore the
adoption of medical-social collaboration in strengthening community care and
rehabilitation services for persons with dementia.
(8) All along the community has different views about the equivalent of the term
"dementia" in Chinese. Chinese nomenclatures such as "腦退化症", "老年癡呆症" and "認知障礙症"
have been widely used by the public to refer to “dementia”. Taking different
views into account, we consider "認知障礙症" a relatively neutral term which will
promote better understanding of the disease. The Government has taken the lead
in using the term "認知障礙症" in government documents. We will continue to encourage
wider adoption of the term "認知障礙症" through education and promotion.
Ends/Wednesday, February 25, 2015
Issued at HKT 16:02
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