Vision for Chinese Medicine & Western Medicine Collaborative Care in HK

1. Vision for Chinese Medicine & Western Medicine Collaborative Care in HK Dr Vivian Taam Wong Director (Strategic Planning) Hospital Authority 23 November 2006

2. Worldwide increasing recognition of the status of Chinese Medicine Rapid growth in collaborative care between CM/WM worldwide Various mode of collaboration due to local legal, ethical & professional considerations Professional Legal Ethical Collaboration betweenCM & WM Source: WHO report 2005

3. Situation in Hong Kong • 1999 • LegCo passed the Chinese Medicine Ordinance • 2001 • Policy Address on establishing CM clinics under public healthcare system • 2003 • Collaboration of WM/CM in treating SARS patients • 2003– 2006 • Established 9 tripartite CM clinics • Piloting collaborative service models

4. Use of CM Service by HK Population (1990-2001) Increasing Demand for CM service Source: Census and Statistics Department

5. CM Service Utilization Source: Census and Statistics Department / HAHO

6. Combined Use of CM/WM Data from 2 HA affiliated CM clinics in 2005 (Total number of patients: 10638) Source: HAHO

7. Networking of HA • Strengthen cooperation with multiple disciplines • CM institutes • Consortium for Globalization of Chinese Medicine (CGCM) • Memorandum of Agreement with Guangdong Provincial TCM Hospital • Liaise with HK Association for Integration of Chinese-Western Medicine (HKAIM) for training programs • Research institutes • HK Jockey Club Institute of Chinese Medicine • Chinese Cochrane Centre HK Branch • Medical / Paramedical professionals • WM practitioners • Nurses • Allied health professionals

8. HA Strategies • Information & Research • Education & Communication • Service Management • Pharmacy & Toxicology

9. HA Strategies • Information & Research • Education & Communication • Service Management • Pharmacy & Toxicology

10. Knowledge Management • Develop evidence-based Chinese Medicine (EBCM) • e-Knowledge Gateway (e-KG) • provides single access to multiple reputable CM databases • Systematic review • Identify scientific and service gaps • Update on new development • Dissemination of information related to CM • Liaise with CM professional bodies in setting up collaborative platform for information sharing

11. Chinese Medicine Information System (CMIS) • Use as platform for data analysis & planning • Nursing assessment & triage • Establish IT module for clinical data collection e.g. influenza • Link up with HA Clinical Management System (CMS) • Incorporate WM code for collaborative patient care

12. Supporting Research • Establish HA wide research ethics (RE) standard procedures • Align CM research ethics standards with WM • Identify CM expert panels in related areas for REC • Set thematic priority for CM research • Advise on research methodologies & statistical analysis for protocol development • Solicit funding to support research projects • Coordinate multi-center trials • Collaborate with overseas organization on CM research

13. Commissioning Research • Herb-drug Interaction • Set up working group with experts on CM/WM pharmacology & pharmacy • Collaborate with universities in conducting animal & clinical studies to address outstanding issue • Collate relevant herb-drug interaction databases • Systematic review • Literature review of disease-based traditional herbal formulae • Provide scientific viewpoint on potential research areas • Facilitate the introduction of proprietary medicine into CM clinics

14. HA Strategies • Information & Research • Education & Communication • Service Management • Pharmacy & Toxicology

15. Training • Certificate Program on CM for WM professionals • Training in clinical trial & research ethics • Current practice series • Neurological disorder and Stroke • Diabetes Mellitus • One-year in-service training program for Junior CMP in HA affiliated CM clinics • Continuing Education for CMP • Collaborate with HKAIM • Debriefing on international meetings

16. CM/WM Interface Guideline • Establish interface guidelines for in-patient service • Harmonize interface issues • Herb-drug interaction • Issuance of sick leave by CMP • Research projects • Complaint management in CM • CM contingency for avian flu outbreak

17. HA Strategies • Information & Research • Education & Communication • Service Management • Pharmacy & Toxicology

18. NGOs Hospital Authority Universities Tripartite Collaboration • HA • Provide policy direction, infrastructure and operational guidance • Information technology support • Central CM pharmacy support • Non-government organizations • Operation of clinics • Universities • Teaching • Research

19. “HACM”– Governance

20. Operation of CM Clinics • Strategic plan for CM service development in 18 districts • Establish manual on service delivery • Oversee CM clinics under HA to achieve targets • Review performance of CM clinics

21. Towards Shared Care Programs • Facilitate patients’ choice on CM, WM or shared care services • Encourage protocol based practice for monitoring & analysis • Focus in treatment modalities & disease conditions with CM advantage • E.g. palliative care, pain, disease prevention • Develop primary care and day care services • Implement sharing of patient information (CMS, CMIS) Source of photos: Sing Tao Daily

22. Preparation for Avian Influenza • CM contingency plan • Incorporate CM service into HA contingency plan as a choice • Outline the role of partnering institutions in preparedness & response • Establish expert group and develop CM guideline on influenza management • Re-arrange CM service delivery • Liaise with experts to provide in-patient consultation • Arrange CM service in designated GOPCs • Stockpile herbs for influenza treatment • Preparation for outbreak • Commission research on herb-drug interaction • Infection control training for staff

23. HA Strategies • Information & Research • Education & Communication • Services Management • Pharmacy & Toxicology

24. CM Pharmacy System • Develop CM pharmacy practice in line with WM standard • Central bulk purchase standard via computer network • Liaise with universities for quality control of herbs • Establish monitor system for herb dispensing • Electronic order entry of herbal formulae • Incorporate with dosage alert, herb-herb interaction alert • Central database for analysis & auditing

25. Toxicology • Establish Toxicology Reference Laboratory • Coordinate CM adverse events notification in HA • Establish databases • Toxicology database • Herb-drug interaction database • Advise frontline staff on herbal toxicology issues • Setup risk management system in CMIS for toxic herbs • Toxicology training

26. Model for CM Research & Translation Modified from “Complementary and Alternative Medicine in the United States”, Institute of Medicine of the National Academies, 2005

27. How therapy function in real world practice? • Who use CM? • How does information influence decision on usage? • What motivate people to use CM? • How people adhere to CM? • What are the outcome of use? • How does CM trigger positive behavioral change?

28. Mission Possible • Set target condition for evaluation • Use surveillance data to design research tools • Develop appropriate methodology for effectiveness study • Identify study sites • Coordinate implementation of protocol

29. Vision for Collaboration

30. THANK YOU