After the event, Lee wondered who answers these community elders’ questions had they not been in the seminar. She later learned from the social workers in the event that oftentimes these questions are left unsolved.
Even though there were social workers stationed in the centre, they lack the necessary knowledge to resolve the elders’ medication-related queries. Moreover, outreach pharmacists was not a popular concept at that time.
Seeing such unmet needs, Lee led a small team of registered pharmacists and about 20 pharmacy students to launch the community outreach service during the summer of the same year. Ten years on, the number of volunteers has grown to nearly 1,500, serving over 10,000 citizens in the city.
In this exclusive interview, current Associate Professor of the School of Pharmacy and the Assistant Dean (Student Development) of the Faculty of Medicine, The Chinese University of Hong Kong (CUHK), Prof Vivian Wing-Yan Lee shares with MIMS how her team grew over the years. More specifically, she explained how this community outreach service has evolved from being a pharmacist outreach service to a multidisciplinary program, serving more people in the society.
A multidisciplinary approach to promote community health and medication safety
“Initially, we focused on educating chronic disease management and resolving drug-related issues amongst the elders,” said Lee. “Later, we realised that the elders need more than just answers to their medication queries… This mission requires the concerted efforts from the other disciplines, not just pharmacy,” she added.
In 2011, the team kick-started its first joint school program with The Nethersole School of Nursing. Two years later, a number of medical students joined the program—it was the first time the outreach team conducted basic ECG monitoring for community elders.
This was also the time the joint school program, CU CHAMPION (Community Health And Medication-safety Promotion Inter-school Outreach Network) was officially inaugurated. The team currently has volunteers from the School of Pharmacy, Faculty of Medicine, The Nethersole School of Nursing, The Jockey Club School of Public Health and Primary Care, School of Chinese Medicine, School of Biomedical Sciences, and the Department of Social Work.
Lee recalled one unforgettable instance when an elder broke into tears during a medication consultation. “She became emotional when the pharmacist asked her if there was anyone who helped her to manage her medications,” she told MIMS. The situation gave Lee a view of the need of these elders beyond medical and/or drug-related issues—an area volunteers from the Department of Social Work can help in.
Primary prevention does not only apply for the service subjects in outreach services
Based on the students’ most relevant experience and expertise, the volunteers were divided into eight service stations during each visit. Medical students are responsible for measuring blood pressure of the elderly members; pharmacy students provide health education and assist in drug counselling session with registered pharmacists; nursing students serve as lifestyle coaches.
While these students are allowed to go from one station to another station to experience other parts of the mission, the junior form students still need to shadow under senior form students or registered personnel of the respective specialty. Students are also required to complete an e-learning course prior to joining the outreach services. The course covers information including disease management, drugs and geriatric care knowledge.
“It is important for students to bear in mind an interdisciplinary approach even before they graduate,” Lee said. “When doctors face drug-related issues, they should seek the help of pharmacists. Equally, when pharmacists encounter problems on fall prevention, they should consult nurses,” she elaborated.
In 2016, CU CHAMPION made another footprint as they launched the Comprehensive Health And Mentorship Program (Champ). The program caters to senior form secondary school students who wish to study Faculty of Medicine programs as their tertiary education. A total of 144 students have joined the program in the year.
“The government has been actively promoting its policy of ageing in place as the core, institutional care as back-up. To me, the responsibilities to strengthen the community care services do not only rely on healthcare professionals. It does not rely on our outreach services as well. Instead, we should shoulder the responsibilities to take care of our family members,” Lee said.
“Once equipped with the necessary knowledge and soft skills through our program, then these secondary students can take care of the elderly members of their families. They can measure blood pressure for them. They can tidy up their pill organizers. They can remind the elderly to live a healthy lifestyle or even go out and exercise with them. This is what the concept of primary prevention and early detection is about.”
Ampoule - an online interactive drug enquiry platform to serve patients around the world
Although Hong Kong is a seemingly wealthy city whose men and women are enjoying the world’s longest life expectancy, some elders are neglected and isolated from the community despite the proximity in the small city.
Apart from serving the community elders, the outreach team has also been receiving a number of requests for outreach service from community centres in other districts. And while it is good that the outreach team has benefited through word of mouth for their service, they do not have sufficient pharmacists and volunteers to serve the elder.
To meet such growing demand, the CUHK School of Pharmacy introduced Ampoule in 2009--an online interactive drug enquiry platform. The platform enables patients to inquire about medications and/or other health-related issue directly with registered pharmacists online.
“People usually submit enquiries relating to the indication, adverse reaction and drug-drug interaction of the medications. Cardiovascular, gastrointestinal and cancer-related drugs are amongst the more common types of medications that we receive,” Lee said. “Those who inquired might not be the patients themselves. Additionally, our peak time is during lunch hours when the working class are free to inquire drug-related issues for their family members,” she added.
To date, Ampoule has accumulated over 5 million hits with an average daily hit of over 3,000 serving patients from 17 origins. “Most of the enquiries are from people living in Hong Kong. Meanwhile, approximately 5% to 10% of the enquiries are coming from the US, Europe, Australia and the Middle East,” said Lee. Although Ampoule offers a bilingual platform, Lee pointed out most of the enquiries are in Chinese. “They have difficulties in communicating with healthcare professionals in their respective countries due to language barrier and physical distance from the healthcare facilities. Therefore, they reach out to us for the enquiries,” she explained.
Asked if this technology can resolve the resource limitation in serving these elders, Lee admitted she initially thought this could be the case. “Ampoule offers a function called ‘Meet My Pharmacist!’ where patients or their family members can talk to our pharmacists through a video call. It is difficult to conduct the call for the elders if either the quality of their webcam is bad or they are not able to hear clearly what our pharmacists say,” Lee explained. “And most importantly, we found out the elders prefer in-person interaction.”
Research, clinical service and teaching (RCT) - three components reinforce and supporting each other
Due to the limitation in resources and manpower, one might wonder if this outreach service is sustainable. Lee emphasized that this is not a one-off service. “For elders with more drug-related issues, our pharmacists follow up with them for an extra six months. If we see improvements in their conditions, then we reduce the frequency of visits or refer them to social workers or Ampoule,” she explained.
Apart from pharmacists who are responsible for organizing outreach services, Lee has also hired three more pharmacists for research purpose. Besides initiating the outreach service, Lee wants to make use of data to validate the effectiveness of their services. If the program proved to be effective, Lee said the same concept could be considered to apply to other regions.
As a non-profit outreach program, expenditures of the team heavily rely on the university’s funding. “I am glad that I have a group of students and teammates who are devoted to this program. Some students even consolidate findings of our program in their final year projects to justify to the university that we are eligible for the fund,” Lee said.
Passion in Action - Where is CU CHAMPION heading?
“Sixteen years ago, my family members asked me if pharmacists are only responsible for counting the number of pills,” Lee recalled. “Today, we collaborate with other professions, to reach out to the community to handle drug-related issues,” she said.
Aside from serving community elders, the team has also expanded their services to ethnic minorities groups and rehab subjects in Hong Kong. “We are planning to expand our footprints outside of Hong Kong, such as Mainland China or other Asian countries. Through overseas experience, students will be able to understand the language barrier in the transfer of disease knowledge. They can also understand the geographical and cultural differences in disease management across various regions,” she explained.
Apart from geographical footprints, Lee added they are planning to recruit volunteers from the Department of Sports Science and Physical Education. “What are the types of exercise could help the elders? This is where sports science volunteers can help,” Lee described. MIMS
About CU CHAMPION (Community Health And Medication-safety Promotion Inter-school Outreach Network):
Since 2007, School of Pharmacy, The Chinese University of Hong Kong, launched the first community outreach service to promote medication safety among elderly population in Hong Kong.
CU CHAMPION was officially inaugurated in October, 2013. As at today, it is a joint schools outreach program with the participation of Faculty of Medicine, School of Pharmacy, The Nethersole School of Nursing, The Jockey Club School of Public Health and Primary Care, School of Chinese Medicine, School of Biomedical Sciences, and Department of Social Work. Learn more.
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