Detection and management of depression in adult primary care patients in Hong Kong: a cross-sectional survey conducted by a primary care practice-based research network

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Patient morbidity and management patterns of community-based primary health care services in Hong Kong

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Where do primary care patients go for mental health care in Hong Kong?

Oral presentation no. 8Conference Theme: Innovations in Primary CareINTRODUCTION The objective of this study was to examine the mental health help-seeking behaviors and preferences among primary care patients and to investigate the socio-demographic and health status factors that predict help-seeking from a primary care physician (PCP). METHOD A cross-sectional survey was conducted on waiting room patients in 59 primary care clinics in public and private settings across Hong Kong. The questionnaire contained the Patient Health Questionnaire-9 and items on socio-demography, previous help-seeking behaviors and help-seeking preferences for depression and mental health. RESULTS 10,179 patients were surveyed with an 81% response rate. When asked who they would seek help from if they were depressed, patients expressed a preference for friends and family (49.1%) over a psychiatrist (26.1%) or PCP (20.1%). Overall men and older patients were less likely to seek help. In terms of professional help, a psychiatrist is more preferred by males while a psychologist or PCP is more preferred by females. In patients with PHQ-9 scores >9, 7.4% had sought the help of a psychiatrist, 4.1% a psychologist and 9.5% a PCP. Patients most likely to seek help from a PCP were female, older, had co-existing illnesses and had milder symptoms of depression. DISCUSSION Approximately a quarter of primary care patients with screened-positive depression reported to have sought professional help for mental health, with more receiving help from a psychiatrist and/or psychologist than a PCP. This has implications for service planning and delivery

Findings of a longitudinal cohort study on depressive disorders in Hong Kong’s primary care

Oral presentationIntroduction: The primary care setting is the entry point for most people into the health system and primary care physicians are ideally placed to serve as the central service provider for patients with depression. Unfortunately, there are many challenges identifying and managing depression in primary care and long-term outcomes and factors affecting prognosis remain unclear. To make recommendations regarding mental health policy, it is necessary to have a current knowledge of the epidemiology and outcomes of depressive disorders in patients presenting to primary care. Methods A cross-sectional followed by a longitudinal cohort study was conducted. Adult patients recruited from the waiting rooms of 59 primary care doctors completed a questionnaire which screened for depression. Doctors provided clinical information about the patient. Consenting patients were followed up by telephone at 3, 6 and 12 months. Results 10,179 subjects were recruited at baseline (response rate 81.0%). 4358 subjects entered the longitudinal study (response rate 42.8%). The cross-sectional prevalence of PHQ-screened depression was 10.69%, 12-month incidence was 6.67% and 12-month remission rate was 60.31%. Detection rate by doctors was 23.1%. Over one year, the health –related quality of life scores improved by 10% (SF-12v2 PCS) and 30% (SF-12v2 MCS). Patient-reported medication and primary care service use was increased; however, mental health service use was low. The most common patient-reported mental health service used was psychiatrists; the most common referral service used by doctors was for counselling. Conclusions Most cases of depression encountered in primary care are mild and self-limiting, but associated with significant impairment to health-related quality of life. Diagnosis of depression by a doctor does not appear to have any significant effect on resolution of symptoms and quality of life after 1 year but is associated with greater improvements in mental health-related quality of life

Facemasks and hand hygiene to prevent influenza transmission in households: A cluster randomized trial

Background: Few data are available about the effectiveness of nonpharmaceutical interventions for preventing influenza virus transmission. Objective: To investigate whether hand hygiene and use of face-masks prevents household transmission of influenza. Design: Cluster randomized, controlled trial. Randomization was computer generated; allocation was concealed from treating physicians and clinics and implemented by study nurses at the time of the initial household visit. Participants and personnel administering the interventions were not blinded to group assignment. (Clinical-Trials.gov registration number: NCT00425893) Setting: Households in Hong Kong. Patients: 407 people presenting to outpatient clinics with influenza-like illness who were positive for influenza A or B virus by rapid testing (index patients) and 794 household members (contacts) in 259 households. Intervention: Lifestyle education (control) (134 households), hand hygiene (136 households), or surgical facemasks plus hand hygiene (137 households) for all household members. Measurements: Influenza virus infection in contacts, as confirmed by reverse-transcription polymerase chain reaction (RT-PCR) or diagnosed clinically after 7 days. Results: Sixty (8%) contacts in the 259 households had RT-PCR-confirmed influenza virus infection in the 7 days after intervention. Hand hygiene with or without facemasks seemed to reduce influenza transmission, but the differences compared with the control group were not significant. In 154 households in which interventions were implemented within 36 hours of symptom onset in the index patient, transmission of RT-PCR-confirmed infection seemed reduced, an effect attributable to fewer infections among participants using facemasks plus hand hygiene (adjusted odds ratio, 0.33 [95% CI, 0.13 to 0.87]). Adherence to interventions varied. Limitation: The delay from index patient symptom onset to intervention and variable adherence may have mitigated intervention effectiveness. Conclusion: Hand hygiene and facemasks seemed to prevent household transmission of influenza virus when implemented within 36 hours of index patient symptom onset. These findings suggest that nonpharmaceutical interventions are important for mitigation of pandemic and interpandemic influenza. Primary Funding Source: Centers for Disease Control and Prevention. © 2009 American College of Physicians.link_to_subscribed_fulltex