Replies to LegCo questions

LCQ12: General out-patient clinics telephone appointment service

Following is a question by the Hon Leung Che-cheung and a written reply by the Secretary for Food and Health, Dr Ko Wing-man, in the Legislative Council today (April 20):

Question:

At present, patients with episodic diseases may book in advance consultation timeslots at general out-patient clinics (GOPCs) within the next 24 hours through the telephone appointment system (appointment system) of the Hospital Authority (HA). In this connection, will the Government inform this Council if it knows:

(1) the respective numbers of consultation quotas reserved for allocation by the appointment system in respect of the morning, afternoon and evening sessions on weekdays and holidays in various GOPCs in New Territories West at present (set out in a table);

(2) regarding the daily consultation quotas reserved for allocation by the appointment system in respect of the morning, afternoon and evening sessions in various GOPCs in New Territories West at present, the respective average time lapse between the commencement of quota allocation and completion of allocation of all quotas (set out in a table);

(3) in each of the past three years, the number of appointments for which patients failed to show up after securing consultation quotas through the appointment system, and the percentage of that number in the total number of appointments; how various GOPCs handled the consultation timeslots concerned;

(4) regarding the situation where patients with episodic diseases, having failed to secure the consultation quotas for GOPCs, switch to seek consultation at the accident and emergency (A&E) departments of public hospitals, whether HA has conducted any study on the pressure caused by such situation to the services of A&E departments; if HA has, of the details; and

(5) whether HA will consider launching a mobile phone application interface for the appointment system, so as to make it more convenient and faster for members of the public to make advance booking for consultation timeslots; if HA will, of the details?

Reply:

President,

My reply to the question raised by the Hon Leung Che-cheung is as follows:

The general out-patient services provided by the Hospital Authority (HA) are primarily targeted at the elderly, the low-income group and the chronically ill. Patients under the care of general out-patient clinics (GOPCs) comprise two major categories: chronic disease patients in stable medical condition, such as patients with diabetes mellitus or hypertension; and episodic disease patients with relatively mild symptoms, such as those suffering from influenza, cold or gastroenteritis. For chronic disease patients requiring follow-up consultations, they will be assigned a visit time slot after each consultation and do not need to make separate appointment. For those with episodic diseases, consultation time slots in the next 24 hours are available for booking through the GOPC telephone appointment system.

Launched in 2006, the GOPC Telephone Appointment Service allows patients to make appointments at home instead of queuing for discs, thereby alleviating the problems of overcrowding and long waiting time in clinics as well as reducing the risk of cross-infection among patients. Through the telephone appointment system, which currently operates round-the-clock with over 650 lines, episodic disease patients can book, at any time of the day, consultation time slots at GOPCs in the next 24 hours. For example, if a patient makes a call through the system in the morning, the system will search for the consultation time slots available from that day to the following morning; and if the patient calls in the afternoon, the system will search for the consultation time slots available from that day to the following afternoon, and so forth.

At present, HA operates eight GOPCs in the New Territories West Cluster (NTWC), namely Tuen Mun Clinic, Yan Oi GOPC and Tuen Mun Wu Hong Clinic in Tuen Mun District, and Yuen Long Jockey Club Health Centre, Madam Yung Fung Shee Health Centre, Kam Tin Clinic, Tin Shui Wai (Tin Yip Road) Community Health Centre and Tin Shui Wai Health Centre in Yuen Long District.

(1) The average number of consultation quotas of the GOPCs in Tuen Mun and Yuen Long Districts for the preceding four weeks (March 20 to April 16, 2016) is set out in the Annex.

(2) and (3) The usage of GOPC services is always a concern for HA. Through the telephone appointment system, consultation quotas of different GOPCs are now pooled together in a network. When a particular clinic has run out of consultation time slots, the system will automatically search for unused quotas of other nearby clinics. This will save patients the trouble of visiting clinics in person to queue for an appointment and optimise the use of consultation quotas within a district. The system will continuously update the quota status of future time slots, including appointments cancelled by patients. When an appointment is cancelled, the quota concerned will be released by the system for booking by other patients to ensure optimal use of consultation quota.

HA has taken various measures to reduce quota wastage caused by patients' failure to show up for scheduled consultations. A message has been added to the telephone appointment system to remind patients to arrive at the clinics 15 minutes before the consultation time or to cancel appointments through the telephone appointment system as early as possible and at least one hour before the consultation time if they are unable to attend the scheduled consultations so that the quotas concerned can be released for booking by other patients. Moreover, HA has an established mechanism to handle cases of failure to show up for scheduled consultations. For patients who make their booking through the telephone appointment system, their use of the system will be suspended if they fail to attend three appointments without prior cancellation within two months. These patients have to visit the clinics in person to go through the necessary procedures should they wish to continue using the GOPC services in the future. HA has also produced educational video clips and pamphlets for broadcasting and distribution at various GOPCs to remind patients of the importance of appointment cancellation and the relevant procedures. The above measures can effectively address the issue of patients' failure to show up for scheduled consultations, thus ensuring the optimal use of consultation quota.

HA understands the strong demand for GOPC services in the community, and that the demand as such may sometimes exceed service provision. To meet the rising service demand of the target users, HA has always endeavoured to improve its GOPC services, including renovating the premises and modernising the facilities of ageing clinics to improve clinic environment, streamline patient flow and increase the space for consultation. HA also actively recruits staff to enhance service capacity.

HA has been actively enhancing GOPC services in Tuen Mun and Yuen Long. Comprehensive primary care services, such as medical consultation services, multi-disciplinary healthcare services, chronic disease management and patient education, are provided at Tin Shui Wai (Tin Yip Road) Community Health Centre, which commenced operation in 2012, at Tin Shui Wai North. Interior renovation and facility modernisation for Yuen Long Jockey Club Health Centre, Madam Yung Fung Shee Health Centre, Tuen Mun Clinic, Yan Oi GOPC and Tuen Mun Wu Hong Clinic were completed during the period from 2011-12 to 2015-16, while interior renovation for Tin Shui Wai Health Centre will be carried out this year. With the implementation of various measures, there has been an increase of over 60 000 attendances in the NTWC from 2012-13 to date, and the GOPC consultation quotas are expected to increase by over 10 000 in 2016-17. In mid-2014, HA also launched the General Out-patient Clinic Public-Private Partnership Programme (GOPC PPP) in Kwun Tong, Wong Tai Sin and Tuen Mun. Clinically stable patients having hypertension with or without hyperlipidemia who have been receiving GOPC services provided by HA for at least 12 months in the three pilot districts are invited to participate in the programme under which they can opt to receive private primary care services in the community. The programme will be extended to cover diabetes mellitus patients. The consultation quotas released under the GOPC PPP can be given to other needy patients to meet service demand. Having considered the initial positive feedback from the medical professional bodies, patients, private doctors and staff, and the community's call for extension to other districts, HA plans to extend the GOPC PPP to nine districts (including Yuen Long District) of the seven clusters in phases starting from the third quarter of 2016. The remaining districts will be covered in 2017-18 and 2018-19. HA will continue to closely monitor the implementation of the GOPC PPP and maintain close communication with the stakeholders.

(4) While the GOPCs are primarily targeted at chronic disease patients in stable medical condition and episodic disease patients with relatively mild symptoms, the GOPC telephone appointment system is mainly established for episodic disease patients to reserve consultation time slots available in the next 24 hours. Although patients with episodic diseases (such as influenza, cold and gastroenteritis) are not in urgent medical condition, HA wishes patients to receive medical attention as soon as possible. As such, the 24-hour appointment arrangement best suits the need of these patients for early medical consultation. The provision of appointment time slot beyond the next 24 hours, however, not only fails to properly address patients' need for early medical consultation, but may also increase their default rate, resulting in quota wastage. HA has thoroughly considered and balanced various factors and views before adopting the 24-hour appointment arrangement.

As the GOPCs are not intended for provision of emergency services, patients with severe and acute symptoms should go to the accident and emergency departments of hospitals where the necessary staffing, equipment and ancillary facilities are in place to provide comprehensive and appropriate treatment and care for them. As the two categories of patients under the care of the GOPCs do not require 24-hour service, HA will not consider operating out-patient services round-the-clock for the time being taking into account the need to ensure efficient use of resources.

(5) The GOPCs provide a huge volume of services, involving about six million GOPC attendances for more than one million patients every year. To optimise the use of resources, the appointment system is currently connected to HA's patient database to verify callers' identity so as to ensure that those allocated consultation time slots are all eligible persons (e.g. Hong Kong Identity Card holders or children aged below 11 with Hong Kong residency status). The purpose is to safeguard the rights of the eligible persons to access GOPC services and avoid quota wastage. Also, the system will search for the suitable type of quotas for patients according to their identity information, e.g. Elderly Appointment Quotas for patients aged 65 or above.

The use of smartphone mobile applications for making appointments involves storage of patients' personal data, and even requires connection to HA's patient database for identity verification. Hence, HA should, when developing mobile applications for this purpose, have comprehensive planning to ensure that, among other things, patients' information is protected. The elderly, the low-income group and the chronically ill are the target users of GOPC services, and their use of mobile applications for making GOPC appointments is expected to be lower than that of telephone. It is easier and more convenient for them to make appointments through telephone. Hence, the telephone appointment system can better safeguard their rights to access GOPC services. HA attaches great importance to the views of various sectors and will maintain an open mind in examining improvement proposals based on the above considerations.

Ends/Wednesday, April 20, 2016
Issued at HKT 19:38

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