Family medicine vocational training and career satisfaction in Hong Kong

Abstract Background Postgraduate vocational training in family medicine (FM) is essential for physicians to build capacity and develop quality primary care. Inadequate standards in training and curriculum development can contribute to poor recruitment and retention of doctors in primary care. This study aimed to investigate: 1) the satisfaction level of doctors regarding vocational training in family medicine and associated demographics; and 2) the satisfaction level of doctors regarding their family medicine career and associated factors. Method This is a cross sectional study of all family medicine physicians across all government-funded primary care clinics (GOPCs). The study questionnaire consisted of items from a standardized and validated physician survey named the Physician Worklife Survey (PWS) (Konrad et al., Med Care, 1999). We selected three scales (7 items) relating to global job satisfaction, global career satisfaction and global specialty (family medicine) satisfaction with additional items on training and demographics. All significant variables in bivariate analyses were further examined using stepwise logistic regression. Results Out of 424 eligible family medicine physicians, 368 physicians successfully completed the questionnaire. The response rate was 86.8%. Most participants were male (52.6%), were aged between 35 and 44 years (55.5%), were FM specialists (42.4%), graduated locally (86.2%), and had postgraduate qualifications. Eighty-two percent (82%) of participants were satisfied with their training. Having autonomy and protected time for training were associated with satisfaction with FM training. Satisfaction with family medicine as a career was correlated with physicians’ satisfaction with their current job. Doctors who did not enroll in training (p < 0.001) and physicians who were older (p = 0.023) were significantly less satisfied. Stepwise multivariate regression showed that doctors who subjectively believed their training as “broad and in depth’ had higher career satisfaction (p < 0.001). Conclusion Overall, the satisfaction level of physicians on current family medicine training in Hong Kong was high. Having autonomy and protected time for training is associated with higher training satisfaction levels. Perceiving FM training as “broad and in-depth” is associated with higher family medicine career satisfaction.

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

Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

BMC Family Practice ◽

10.1186/s12875-021-01455-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

FU Leung Chan ◽

Yim Chu Li ◽

Xiao Rui Catherine Chen

Keyword(s):

Primary Care ◽

Logistic Regression ◽

Clinical Practice ◽

Stepwise Logistic Regression ◽

Continuous Variables ◽

Cross Sectional ◽

Case Register ◽

Negatively Associated ◽

Therapeutic Inertia ◽

Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

Download Full-text

Geographical distribution of family physicians in Japan: A nationwide cross-sectional study

10.21203/rs.2.10782/v1 ◽

2019 ◽

Author(s):

Shuhei Yoshida ◽

Masatoshi Matsumoto ◽

Saori Kashima ◽

Soichi Soichi Koike ◽

Susumu Tazuma ◽

...

Keyword(s):

Primary Care ◽

Family Medicine ◽

Rural Areas ◽

Census Data ◽

Family Physicians ◽

Cross Sectional Study ◽

Government Support ◽

Free Access ◽

Cross Sectional ◽

Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

Download Full-text

Perspectives of primary care physicians on acceptance and barriers to COVID-19 vaccination

Family Medicine and Community Health ◽

10.1136/fmch-2021-001228 ◽

2021 ◽

Vol 9 (4) ◽

pp. e001228

Author(s):

Philip Day ◽

Chance Strenth ◽

Neelima Kale ◽

F David Schneider ◽

Elizabeth Mayfield Arnold

Keyword(s):

Primary Care ◽

Family Medicine ◽

Primary Care Physicians ◽

Local Community ◽

Professional Associations ◽

Vaccine Uptake ◽

Vaccine Hesitancy ◽

Online Questionnaire ◽

Cross Sectional ◽

Patient Concerns

ObjectivesThe purpose of this study was to examine the perspectives of primary care physicians in Texas around vaccine acceptance and potential patient barriers to vaccination. National surveys have shown fluctuating levels of acceptance for COVID-19 vaccination, and primary care physicians could play a crucial role in increasing vaccine uptake.DesignThis study employed a cross-sectional anonymous survey design to collect data using an online questionnaire. Participants were asked about vaccination practices and policies at their practice site, perceptions of patient and community acceptance and confidence in responding to patient vaccine concerns.SettingFrom November 2020 to January 2021, family medicine physicians and paediatricians completed an online questionnaire on COVID-19 vaccination that was distributed by professional associations.ParticipantsThe survey was completed by 573 practising physicians, the majority of whom identified as family medicine physicians (71.0%) or paediatricians (25.7%), who are currently active in professional associations in Texas.ResultsAbout three-fourths (74.0%) of participants reported that they would get the vaccine as soon as it became available. They estimated that slightly more than half (59.2%) of their patients would accept the vaccine, and 67.0% expected that the COVID-19 vaccine would be accepted in their local community. The majority of participants (87.8%) reported always, almost always or usually endorsing vaccines, including high levels of intention to recommend COVID-19 vaccination (81.5%). Participants felt most confident responding to patient concerns related to education about vaccine types, safety and necessity and reported least confidence in responding to personal or religious objections to COVID-19 vaccination.ConclusionsThe majority of the physicians surveyed stated that they would receive the COVID-19 vaccination when it was available to them and were confident in their ability to respond to patient concerns. With additional education, support and shifting COVID-19 vaccinations into primary care settings, primary care physicians can use the trust they have built with their patients to address vaccine hesitancy and potentially increase acceptance and uptake.

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

Comparison of self-report and objective measures of male sexual dysfunction in a Japanese primary care setting: a cross-sectional, self-administered mixed methods survey

Family Medicine and Community Health ◽

10.1136/fmch-2020-000403 ◽

2021 ◽

Vol 9 (1) ◽

pp. e000403

Author(s):

Yuki Takeuchi ◽

Ryohei Otsuka ◽

Hajime Kojima ◽

Michael D Fetters

Keyword(s):

Primary Care ◽

Mixed Methods ◽

Sexual Dysfunction ◽

Family Medicine ◽

Care Setting ◽

Primary Care Setting ◽

Cross Sectional ◽

Medicine Clinic ◽

Barriers To Access ◽

Male Patients

ObjectivesErectile dysfunction (ED) is a common problem among middle-aged males and men often do not talk about sexual problems with their primary care physicians (PCPs). We hypothesised that many Japanese men who meet the criteria for ED would not recognise their condition based on responses to an internationally validated scale. Our secondary aims were to examine potential barriers to seeking treatment for ED by their PCPs. We sought to elucidate their perspectives about male sexual dysfunction qualitatively. Through merging of the quantitative and qualitative findings, we sought an enhanced understanding of the factors affecting sexual dysfunction treatment.DesignA cross-sectional, self-administered mixed methods survey was distributed at a suburban family medicine clinic in Sapporo, Japan. Eligible participants were 40 to 69-year-old men who came for routine scheduled visits from 5 November to 21 December 2018. During the office visit, participants completed a confidential 11-item survey addressing sexual dysfunction including the 5-item version of the International Index of Erectile Function scale and open-ended questioning.SettingTeine Family Medicine Clinic, a suburban family medicine clinic in Sapporo, Japan.ParticipantsWe enroled 66 male patients aged 40–69 years who presented for routine outpatient care in the Teine Family Medicine Clinic.ResultsOf surveyed participants, 39% (26/66) reported having sexual dysfunction, but 92% (61/66) met ED criteria. Of respondents, 48% (16/33) had desire for treatment, but only one man had discussed sexual dysfunction with his PCP. Among the 12 desiring treatment from PCPs, the main barriers to discussing were shame (n=7) and lack of awareness that PCPs can treat ED (n=5). These men’s perspectives about sexual dysfunction included viewing sexual dysfunction as normal ageing, attributing sexual dysfunction to decreased libido, considering sexual activity for a healthy life, having good rapport with PCPs, having incomplete knowledge about treatment and lacking an intimate relationship. Through a resulting model, the merged mixed methods findings illustrate how patient perceptions can reinforce or attenuate issues of awareness, desire for treatment and barriers to access.ConclusionsIn a Japanese primary care setting, the majority of participating male patients met ED criteria on an internationally validated measure, namely, the five-item version of the International Index of Erectile Function, but many were not aware of their ED. Misperceptions, lack of knowledge and personal factors are barriers to treatment. The mixed methods findings suggest misperceptions and personal attributes reinforce or attenuate awareness, preference for treatment and barriers to access. We conclude PCPs should routinely inquire about sexual dysfunction of men at risk and offer treatment to men who would benefit.

Download Full-text

The Chinese-version of the CARE Measure reliably differentiates between doctors in primary care: a cross-sectional study in Hong Kong

BMC Family Practice ◽

10.1186/1471-2296-12-43 ◽

2011 ◽

Vol 12 (1) ◽

Cited By ~ 17

Author(s):

Stewart W Mercer ◽

Colman SC Fung ◽

Frank WK Chan ◽

Fiona YY Wong ◽

Samuel YS Wong ◽

...

Keyword(s):

Primary Care ◽

Hong Kong ◽

Cross Sectional Study ◽

Chinese Version ◽

Sectional Study ◽

Cross Sectional ◽

Care Measure

Download Full-text

Preference of blood pressure measurement methods by primary care doctors in Hong Kong: A cross-sectional survey

10.21203/rs.2.20342/v1 ◽

2020 ◽

Author(s):

Eric Kam Pui Lee ◽

Ryan Chun Ming Choi ◽

Licheng Liu ◽

Tiffany Gao ◽

Benjamin Hon Kei Yip ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Hong Kong ◽

Blood Pressure Measurement ◽

Real Life ◽

Measurement Methods ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Common Chronic Disease ◽

Diagnosis And Management

Abstract Background Hypertension is the most common chronic disease and is the leading cause of morbidity and mortality. Its screening, diagnosis, and management depend heavily on accurate blood pressure (BP) measurement. It is recommended that the diagnosis of hypertension should be confirmed or corroborated by out-of-office BP values, measured using ambulatory BP monitoring (ABPM) and home BP monitoring (HBPM). When office BP is used, automated office BP (AOBP) measurement method, which automatically provides an average of 3–5 BP readings, should be preferred. This study aimed to describe the BP measurement methods commonly used by doctors in primary care in Hong Kong, to screen, diagnose, and manage hypertensive patients.Methods In this cross-sectional survey, all doctors registered in the Hong Kong “Primary Care Directory” were mailed a questionnaire, asking their preferred BP-measuring methods to screen, diagnose, and manage hypertensive patients. Furthermore, we also elicited information on the usual number of office BP or HBPM readings obtained, to diagnose or manage hypertension.Results Out of the 1738 doctors in the directory, 445 responded. Manual measurement using a mercury or aneroid device was found to be the commonest method to screen (63.1%), diagnose (56.4%), and manage (72.4%) hypertension. There was a significant underutilisation of ABPM, with only 1.6% doctors using this method to diagnose hypertension. HBPM was used by 22.2% and 56.8% of the respondents to diagnose and manage hypertension, respectively. A quarter (26.7%) of the respondents reported using only one in-office BP reading, while 40% participants reported using ≥12 HBPM readings. Doctors with specialist qualification in family medicine were more likely to use AOBP in clinics and to obtain the recommended number of office BP readings for diagnosis and management of hypertension.Conclusion Doctors in Hong Kong primary care prefer to use manual office BP values, measured using mercury or aneroid devices, to screen, diagnose, and manage hypertension, highlighting a marked underutilisation of AOBP and out-of-office BP measuring techniques, especially that of ABPM. Further studies are indicated to understand the underlying reasons and to minimise the gap between real-life clinical practice and those recommended, based on scientific advances.

Download Full-text

Evaluation of a Musculoskeletal Ultrasound Workshop in the Family Medicine Clerkship

Family Medicine ◽

10.22454/fammed.2022.378370 ◽

2022 ◽

Vol 54 (1) ◽

pp. 54-57

Author(s):

Megan L. Ferderber ◽

Kaitlyn Vann ◽

Athanasios Tzaras ◽

Noam Hadadi ◽

Rebecca M. Gilbird

Keyword(s):

Primary Care ◽

Family Medicine ◽

Point Of Care ◽

Musculoskeletal Ultrasound ◽

Medicine Clerkship ◽

Protected Time ◽

Hands On ◽

The Family ◽

And Performance ◽

Academic Year

Background and Objectives: The family medicine (FM) clerkship is appropriate for incorporating musculoskeletal ultrasound (MSKUS) education, as many outpatient visits in primary care occur for musculoskeletal (MSK) concerns. Despite rising popularity of point-of-care imaging in primary care, ultrasound (US) training in medical education is limited due to lack of resources and time. The purpose of this study is to evaluate the effects of an MSKUS workshop in the FM clerkship through student self-evaluations. Methods: Seventy-five medical students enrolled in the FM clerkship during the 2019-2020 academic year participated in hands-on MSKUS workshops staffed by faculty, residents, and a fellow. Workshops coincided with FM residency didactic teaching, allowing for protected time to host US training. Of workshop participants, 98.6% completed both pre- and postworkshop evaluations assessing confidence and acceptability of the workshop (rated on a 0-10 Likert scale, where higher scores represent more confidence or greater benefit, respectively). Results: Students noted increased confidence with use of ultrasound, recognition of MSK structures, and performance of landmark-guided procedures (preworkshop 2.6±1.6; postworkshop 7.4±1.1). Students endorsed high levels of agreement in the benefit of the workshop to their education (9.4±1.3) and MSK understanding (9.4±1.2). Conclusions: This study demonstrates the benefit of an MSKUS workshop as part of the FM clerkship and addresses previously identified challenges to providing US education. Results suggest a short-term benefit from an MSKUS workshop in confidence in MSKUS knowledge and satisfaction with the curriculum.

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