Comparison of primary care experiences among adults in general outpatient clinics and private general practice clinics in Hong Kong

PurposeThis is an ongoing prospective cohort aiming to examine the biopsychosocial health profiles and predictors of health outcomes of older patients with multimorbidity in primary care in Hong Kong.ParticipantsFrom April 2016 to October 2017, 1077 patients aged 60+ years with at least two chronic diseases were recruited in four public primary care clinics in the New Territories East Region of Hong Kong.Findings to dateAfter weighting, the patients had 4.1 (1.8) chronic conditions and 2.5 (1.9) medications on average; 37% forgot taking medication sometimes; 71% rated their health as fair or poor; 17% were frail; 73% reported one (21%) or two or more (52%) body pain areas; 62% were overweight/obese; 23% reported chewing difficulty, 18% reported incontinence; 36% had current stage 1/2 hypertension; 38% had handgrip strength below the cut-off; 10% screened positive in sarcopenia; 17% had mild or severer cognitive impairment; 17% had mild to severe depression; 16% had mild to severe anxiety; 50% had subthreshold to severe insomnia; 28% indicated being lonely; 12% needed help in at least one out of the five daily functions and the EuroQoL-5-Dimensions-5-Level index score was 0.81 (0.20) and its Visual Analogue Scale (VAS) score was 67.6 (14.6). In the past 12 months, 17% were hospitalised, 92% attended general outpatient clinics, 70% attended specialist outpatient clinics and 10% used elderly daycare centre services, the median out-of-pocket health cost was HK$1000 (US$150). Female and male patients showed significant differences in many biopsychosocial health aspects.Future plansWith assessments and clinical data, the cohort can be used for understanding longitudinal trajectories of biopsychosocial health profiles of Chinese older patients with multimorbidity in primary care. We are also initially planning cohort studies on factors associated with various health outcomes, as well as quality of life and healthcare use.Cohort registration numberChiCTR-OIC-16008477

Download Full-text

Cost comparison of psychiatric outpatient clinics based in hospitals and in primary care (general practice health center)

Acta Psychiatrica Scandinavica ◽

10.1111/j.1600-0447.1995.tb09539.x ◽

1995 ◽

Vol 92 (1) ◽

pp. 30-34 ◽

Cited By ~ 1

Author(s):

A. Shah

Keyword(s):

Primary Care ◽

General Practice ◽

Health Center ◽

Cost Comparison ◽

Outpatient Clinics ◽

Psychiatric Outpatient

Download Full-text

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

BMC Geriatrics ◽

10.1186/s12877-020-01851-x ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Johnny T. K. Cheung ◽

Samuel Y.S. Wong ◽

Dicken C. C. Chan ◽

Dexing Zhang ◽

Lawrence H. F. Luk ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Hong Kong ◽

Chronic Disease ◽

Disease Management ◽

Continuity Of Care ◽

Chronic Disease Management ◽

Outpatient Clinics ◽

Cross Sectional ◽

The Public

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective. Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73). Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Download Full-text

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

10.21203/rs.3.rs-34748/v2 ◽

2020 ◽

Author(s):

Johnny Cheung ◽

Samuel Y.S. Wong ◽

Dicken C. C. Chan ◽

Dexing Zhang ◽

Lawrence H.F. Luk ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Hong Kong ◽

Chronic Disease ◽

Disease Management ◽

Continuity Of Care ◽

Chronic Disease Management ◽

Outpatient Clinics ◽

Cross Sectional ◽

The Public

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care.Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective.Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73).Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Download Full-text

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

10.21203/rs.3.rs-34748/v3 ◽

2020 ◽

Author(s):

Johnny Cheung ◽

Samuel Y.S. Wong ◽

Dicken C. C. Chan ◽

Dexing Zhang ◽

Lawrence H.F. Luk ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Hong Kong ◽

Chronic Disease ◽

Disease Management ◽

Continuity Of Care ◽

Chronic Disease Management ◽

Outpatient Clinics ◽

Cross Sectional ◽

The Public

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care.Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics of the public healthcare sector in Hong Kong. We used multiple logistic regression to address the study objective.Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73).Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Download Full-text

Can voucher scheme enhance primary care provision for older adults: cross-sectional study in Hong Kong

10.21203/rs.3.rs-34748/v1 ◽

2020 ◽

Author(s):

Johnny Cheung ◽

Samuel Y.S. Wong ◽

Dicken C. C. Chan ◽

Dexing Zhang ◽

Lawrence H.F. Luk ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Hong Kong ◽

Chronic Disease ◽

Disease Management ◽

Private Sector ◽

Continuity Of Care ◽

Chronic Disease Management ◽

Outpatient Clinics ◽

Cross Sectional

Abstract Background The Hong Kong government has launched the Elderly Health Care Voucher (EHCV) scheme to facilitate primary care in the private sector for older adults. This study aimed to examine whether voucher use was associated with a shift of healthcare burden from the public to the private sector, vaccine uptake and continuity of care. Methods This cross-sectional survey recruited older adults with ≥3 chronic diseases through convenience sampling from seven general outpatient clinics, seven geriatric day hospitals, and five specialist outpatient clinics in Hong Kong. We used multiple logistic regression to address the study objective. Results A total of 1032 patients participated in the survey. We included 714 participants aged 70 or above in the analysis. EHCV use was associated with higher utilization of private primary care services, including general practitioner and family doctor (Adjusted Odds Ratio (AOR) 2.67, 95% Confidence Interval (95%CI) 1.51–4.72) and Chinese medicine clinic (AOR 3.53, 95%CI 1.47–8.49). There were no significant associations of EHCV use with public general outpatient clinic attendance, Accident & Emergency attendance, and hospitalization. Furthermore, EHCV users were more likely to receive pneumococcal vaccination (AOR 2.17, 95%CI 1.22–3.85) and were less likely to visit the same doctors for chronic disease management (AOR 0.10, 95%CI 0.01–0.73). Conclusions While the EHCV may promote private primary care utilization and preventive care, older patients continue to rely on public services and the EHCV may worsen continuity of care. Policy-makers should designate voucher usage for chronic disease management and continuity of care.

Download Full-text

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

British Journal of General Practice ◽

10.3399/bjgp20x711053 ◽

2020 ◽

Vol 70 (suppl 1) ◽

pp. bjgp20X711053

Author(s):

Luamar Dolfini ◽

Yogesh Patel

Keyword(s):

Primary Care ◽

General Practice ◽

Acne Vulgaris ◽

Clinical Information ◽

Electronic Record ◽

Self Management ◽

Considerable Proportion ◽

Dry Skin ◽

Record System ◽

Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

Download Full-text