What type of primary care services does the public want?

Objective: To find out what type of primary care services the public in Hong Kong wants. Design: Cross sectional population telephone survey. Subjects: 996 Cantonese speaking Chinese adults aged 21 years or above were randomly selected from households in Hong Kong. Main outcome measures: People's preference for the type of practices, doctors, access systems, consultations and other services in primary care. Results: Most people preferred to consult the same doctor close to their homes. Many people wanted doctors to be available in the evenings, weekends and public holidays. More people preferred a walk-in than a telephone appointment system. Most thought it was important for their primary care doctors to have higher medical qualifications. More people preferred male to female doctors. The majority (68%) thought an average consultation should last for more than 5 minutes. Over 90% thought it was important for the doctor to give detailed explanations on their illnesses and treatments. Many wanted primary care practices to provide preventive care. Thirty-seven percent of subjects would consult specialists without referrals. Thirty percent of people agreed that nurses could be responsible for following up chronic diseases but only 16% thought they could treat minor illnesses. Conclusion: The study confirmed that the public wanted accessible, available and comprehensive primary care services provided by doctors with postgraduate higher medical qualifications. Contrary to previous beliefs, most people preferred to consult the same doctor all the time and people wanted explanation as much as medications from doctors.published_or_final_versio

Is a desk-top analyzer the answer to cholesterol screening?

This is the first evaluation study on the acceptability and accuracy of the Reflotron, a desktop analyzer for cholesterol screening in general practice in Hong Kong. Patients aged 21-60 attending a Government general outpatient clinic in Hong Kong were randomly selected. The acceptance rate of screening was 69%. A total of 1113 subjects had their cholesterol levels screened by the Reflotron. The accuracy of the Reflotron was assessed by comparing its results to laboratory blood cholesterol (BC) results in 125 subjects. The mean error of the Reflotron cholesterol measurements was 6% which was larger than that recommended by the American National Cholesterol Education Programme. Therefore, the diagnosis or treatment of hypercholesterolaemia should not be based on the Reflotron result alone. There was a good linear correlation between the Reflotron cholesterol (RC) and blood cholesterol (BC) with a negative bias in the Reflotron results. Blood cholesterol could be predicted from RC by the regression equation: BC = 0.8395 + 0.8995 x RC. The Reflotron is useful as an initial screening test for hypercholesterolaemia in the low risk population. The threshold levels need to be adjusted accordingly, and abnormal results should be confirmed by standard laboratory tests. It is estimated that one could save H.K.$51.6 million if the Reflotron instead of the laboratory were used to screen all people aged 40 to 60 years old in Hong Kong once.published_or_final_versio

Is hypercholesterolaemia common among Hong Kong Chinese?

There is growing concern that coronary heart disease (CHD) is becoming more common and that hypercholesterolaemia may be an important problem among Hong Kong Chinese. This study aims at finding out the prevalence of hypercholesterolaemia among adult patients in general practice. 1113 Chinese patients aged 21 to 60 attending a Government general outpatient clinic were randomly sampled. The demographic data and information on other CHD risk factors were obtained from each participant. All participants had their cholesterol measured by the Reflotron. The reflotron cholesterol results were validated and calibrated against laboratory results. The survey showed 10% of the sample had blood cholesterol > 6.2mmol/l, and 32% had borderline hypercholesterolaemia between 5.2 to 6.2mmol/l. Less than 1% of the people had cholesterol levels above 7.8mmol/l. Age had the most significant effect on cholesterol level especially in females after 40. One in four females over 50 had blood cholesterol levels > 6.2mmol/l. Twentyone percent of the sample had > 2 other CHD risk factors, over half of them had cholesterol >5.2mmol/l. The main problem among Hong Kong Chinese is borderline hypercholesterolaemia which is most significant in people with additional CHD risk factors. Cholesterol screening will be more costeffective if directed to people known to have other CHD risk factors but may not be worthwhile for the low risk group.published_or_final_versio

A pill for every ill?

Many doctors believe that Chinese expect a pill for every ill but this has never been validated by research data. The aim of our study was to find out what Chinese really expect from medications when they are ill. We interviewed a random sample of the 1068 Chinese in Hong Kong by telephone with a structured questionnaire. Only 40% thought illnesses always needed drug treatment but 76% always expected a prescription from a consultation. Nearly 100% of their last consultations resulted in a prescription. Eighty-five per cent of the prescriptions consisted of three drugs or more. Seven per cent of them thought too many drugs were given. Less than half of the people finished all the medications last prescribed. Those who thought too many drugs were given were less likely to have finished them. Younger age and more education were associated with less likelihood of thinking illnesses always needed drug treatment, consulting doctors for their last illnesses and expecting a prescription for every consultation. We conclude that Chinese do not expect a pill for every ill but doctors prescribe in nearly 100% of the consultations. Doctors may have over-estimated Chinese patients' expectation for medications. They may even have created a high expectation for a prescription in every consultation through their own prescribing habit. More open discussion on the need and expectation for drugs between patients and doctors may help to make prescribing for Chinese patients more rational.link_to_subscribed_fulltex

Self-medication among Hong Kong Chinese

A randomized telephone survey on the practice of self-medication in the preceding 2 weeks was carried out from October 1989 to April 1990 among Chinese living in Hong Kong. 1068 people were interviewed. Self-medication was a common and universal practice by Hong Kong Chinese with a prevalence of 32.5% in 2 weeks. Those who reported illness were significantly more likely than those who did not use self-medication (65 vs 18.2%) and to have used more than one item of medications (39 vs 20%). Chinese tonics were the most frequently used self-medications although they were the least known. Chinese medicines were used as often as Western medicines in the self-treatment of illnesses. People used self-medication mainly because they felt that they knew what to do. About 80% of the Western and Chinese medicines were perceived to be effective but only 49% of the tonics were reported so. Side effects were reported from all types of medications with an overall prevalence of 6.4%. There was a lack of knowledge of the possible side effects in over 96% of the self-medications which is an area for patient education. The popularity but the relative lack of knowledge of Chinese tonics call for more scientific research and better regulation on their sales.link_to_subscribed_fulltex