From Early Detection Service to Shared Care Model: the Hong Kong Experience

Abstract

The benefits of early intervention and care in dementia are receiving increasing attention. Even in higher-income areas such as Hong Kong, however, a number of barriers need to be overcame to realize this vision. These include a high under-diagnosis rate at 89% in the community and long waiting time to access specialist diagnostic consultation services, and lack of awareness in the general public to detect early symptoms and signs to initiate timely help-seeking. A recent study in Hong Kong has demonstrated the potentials of an Early Detection Service by trained social workers and occupational therapists that collaborates with general practitioners and medical specialists in the community. A shared care model is being developed and piloted by the Hong Kong Alzheimer’s Disease Association (HKADA) in an age-friendly district. The aims are to build up care capacity in the district, to develop a district-based community shared-care model for future replication in other districts, and to strengthen medico-social and public-private interfacing through the shared-care model. A 3-year project designed with multiple interdependent components is being evaluated. The components include public education and awareness, early detection and diagnosis, and early interventions including advance care planning and coordination, drug treatment, and non-drug interventions provided at a specialized dementia day centre in the district. A total of 120 families with dementia are enrolled into a 2-year follow-up study to investigate the quality of life and intention of ageing in place among participants in the project as compared with those receiving traditional forms of services in Hong Kong. Assessments will be done at baseline, 6-month, 12-month, and 24-month follow-up. Cost of care is measured in a subsample of 30 families to estimate the direct and indirect costs associated with the shared-care model compared with traditional services among community-dwelling families with dementia in Hong Kong. Focus groups, interviews and questionnaire survey with stakeholders (families with dementia, general practitioners, dementia care planner, NGO staff) as formative evaluation to generate ideas for continual improvement and roll-out in other districts. Data collection has started in November 2015. This paper presents the preliminary findings from focus groups and questionnaire survey with stakeholders, as well as baseline and 6-month data available from the 2-year follow-up study.