Epidemiology and Natural History of Depressive Disorders in Hong Kong's Primary Care

This journal suppl. entitled: Health Research Symposium 2014: Commissioned Research on Mental Health Policy and Services: Research Dissemination Reportspublished_or_final_versio

Evaluation of quality of care of Chronic Disease Management Programmes and Public-private Partnership Programmes of the Hospital Authority

This journal suppl. entitled: Health Research Symposium 2014 - Commissioned Research on Mental Health Policy and Services: Research Dissemination ReportsParallel Session 3: Delivery of Health Services: no. S12Symposium Theme: Translating Health Research into Policy for Health of the PopulationTo improve the quality of care of patients with chronic diseases in primary care, the Hong Kong Hospital Authority introduced a series of chronic disease management and public-private partnership programmes: Risk Factor Assessment and Management Programme and Patient Empowerment Programme for patients with diabetes mellitus and hypertension, Nurse and Allied Health Clinics programme, and Haemodialysis – Public Private Partnership Programme. Dr Chin and colleagues aimed to evaluate and enhance the quality of care of these programmes to assure that best practices and outcomes can be achieved. Dr Chin found that all …published_or_final_versio

Trajectory Pathways for Depressive Symptoms and Their Associated Factors in a Chinese Primary Care Cohort by Growth Mixture Modelling

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Validation of the International Prostate Symptoms Score in Chinese males and females with lower urinary tract symptoms

Objectives To evaluate the translation of the IPSS (Hong Kong Chinese version 1) and to assess the applicability, validity, reliability and sensitivity of the instrument in both males and females with LUTS in Chinese population. Methods The translation of the IPSS (Hong Kong Chinese version 1) was reviewed through back translation. Modifications were made, resulting in the development of The IPSS (Hong Kong Chinese version 2). The content validity was assessed by contend validity index. 233 subjects with LUTS were recruited in Hong Kong primary care settings for pilot psychometric testing. The construct validity was assessed by corrected item-total correlation and Pearson’s correlation test against ICIQ-UI SF, IIQ-7 and SF-12 v2. The reliability was assessed by the internal consistency (Cronbach’s Alpha coefficient) and test –retest reliability (Intraclass correlation coefficient). The Sensitivity was determined by performing known group comparisons by independent T-test. Results The content validity index for all items could reach 1. Corrected item-total correlation scores were ≥0.4 for four symptom questions (feeling of incomplete bladder emptying, intermittency, weak stream and straining). Overall, the total symptom score moderately correlated with ICIQ-UI SF. The quality of life score moderately correlated with the IIQ-7 but weakly correlated with SF-12 v2. Overall, the reliability of the IPSS (Hong Kong Chinese version 2) was acceptable (Cronbach’s Alpha coefficient = 0.71, ICC of the symptom questions =0.8, ICC of the quality of life question =0.7). The symptoms questions and quality of life questions of the IPSS (Hong Kong Chinese versions 2) were sensitive in detecting differences between groups. Conclusions The IPSS (Hong Kong Chinese version 2) is a valid, reliable and sensitive measure to assess Chinese females and males with lower urinary tract symptoms. The IPSS quality of life question is more sensitive than the generic quality of life measure to differentiate subgroups.published_or_final_versio

Quality of care of nurse-led and allied health personnel-led primary care clinics

Objectives To review the literature regarding quality of care of nurse-led and allied health personnel-led primary care clinics with specific attention to the quality indicators for fall prevention, continence care, pulmonary rehabilitation, mental health, pharmaceutical care, and wound care services. Data sources Literature search from 1990 to 2010 including Ovid Medline, Cochrane Database, RAND (Research and Development) Corporation Health Database, the ACOVE (Assessing the Care of Vulnerable Elders) project and clinical guidelines from the United Kingdom, Australia, Canada, and the United States. Study selection This review was limited to studies involving adult, primary care patients. Where available, evidence from systematic reviews and meta-analyses were used to synthesize findings. Data extraction Combinations of the following terms (and related terms) were used to identify studies: primary care, clinic, allied-health, nurse-led, fall prevention, continence care, incontinence, chronic obstructive pulmonary disorder, pulmonary disease, respiratory rehabilitation, mental health, mental wellbeing, depression, anxiety, wound care, leg ulcer, venous ulcer, dressings clinic, wound clinic, medication review, pharmacist-led, pharmaceutical care. Data synthesis A total of 21 international guidelines and 33 studies were selected for data synthesis. Despite a lack of consistent outcomes data, it is apparent that certain aspects of organizational structure and clinical care processes are important though not necessarily sufficient indicators of quality of care, because they themselves can influence care outcomes. Seven key factors were identified which seem important determinants of the quality of care provided by nurse- and allied health personnel-led clinics. Conclusion Delivery of primary health care by nurse and allied health personnel-led teams is a well-established model, internationally. Evidence from the literature provides benchmarks for standards of good practice. Knowledge of factors influencing quality of care can assist the planning, implementation, evaluation, and further expansion of such programmes, locally.published_or_final_versio

Evaluation of the internal and external responsiveness of the Pressure Ulcer Scale for Healing (PUSH) tool for assessing acute and chronic wounds

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Association of More Negative Attitude towards Commencing Insulin with Lower Glycosylated Hemoglobin (HbA1c) Level: A survey on Insulin-naïve Type 2 Diabetes Mellitus Chinese Patients

Aims: This study examined the correlation between socio-demographic and clinical characteristics; and attitudes towards commencing insulin in Chinese primary care patients with Type 2 Diabetes Mellitus (DM). Method: A cross-sectional survey was conducted on 303 insulin-naïve Type 2 DM patients recruited from 15 primary care clinics across Hong Kong using the Chinese Attitudes to Starting Insulin Questionnaire (Ch-ASIQ). Subject selection criteria were patients on maximal oral anti-diabetes treatment who needed to commence insulin therapy. Linear regression was used to identify correlations between age, sex, educational level, occupation, body mass index, diabetes disease duration, laboratory test indicating disease control and biochemical markers including glycosylated hemoglobin (HbA1c) level , low density lipoprotein level and estimated glomeruli filtration rate, and presence of diabetic complications with the four sub-scales (self-image and stigmatization; factors promoting self-efficacy; fear of pain or needles; time and family support ) and the overall Ch-ASIQ score. Results: The most prevalent negative attitude was ‘fear of needle injections’ (70.1%). The most common positive attitude was ‘I can manage the skill of injecting insulin’ (67.5%). The mean Ch-ASIQ score of 2.50 (S.D.=0.38) was equal to the mid-score, which signified an overall ambivalent attitude among the study population. Women scored significantly higher in the fear of pain or needles subscale (p=0.011) and had an overall more negative attitude towards commencing insulin (p=0.016). Subjects with lower HbA1c levels also had a significantly lower Ch-ASIQ sum score (p=0.048) indicating a more negative attitude towards commencing insulin. Conclusion: In Chinese primary care patients with Type 2 DM, the need to commence insulin was associated with a number of negative emotions, which lead to a lower motivation to accept treatment. Perception of need as indicated by HbA1c level may be an important influencing factor determining a patient’s overall attitude towards starting insulin. Fortunately, in our setting, the injection technique does not appear to be a major barrier. However, needle fears are common, especially amongst women. Target interventions to acknowledge and help them to overcome their fears are essential before insulin treatment is commenced.published_or_final_versio

A pilot study to identify quality criteria for community -based medical education in Hong Kong

BACKGROUND: To better prepare students for the health needs of society, there is pressure on medical svhools to provide greater learning opportunities in the community. On challenge is the on-going quality assurance of these programs. Before setting benchmark standards for quality evaluation, a relevant set of criteria must first be defined. the aim of this study was to identify a locally relevant set of quality criteria for assuring undergraduate medical community-based learning in Hong Kong METHODS: An audit of the MBBS curriculum was undertaken to identify all eligible community-based learning activities and to obtain information regarding learning objectives, assessments and quality assurance methods. Semi-structured interviews with program coordinators were conducted to explore their perceptions reagrding factors influencing the educational quality of their courses. Interviews were taped, transcripbed and contents thematically analyzed. RESULTS: 10 program coordinators, representing 14 of the 18 eligible programs were interviewed. 59 items were identified and classifed as structural, process or outcome criteria. Physical cahracteritsing of the learning sites such as size, and accessibility, attributes of the teachers, adequate resourcing for community-based leasrning and stability of community partnerships emergeed as key criteria affecting student learning, whilst professionalism and community-based values towards learning or working in community settings and towards service utilization emerged as key outcomes. CONCLUSION: Community-based learning in Hong Kong has unique challenges whicih require close attention. In order ro ensure the sustainability of the programs, effforts are needed to indentify ways to nurture and maintain realtaionships with community partners with reciprocal benefits.published_or_final_versio

Assessing medical student empathy in a family medicine clinical test: validity of the CARE measure

Introduction: The Consultation and Relational Empathy (CARE) measure developed and validated in primary care settings and used for general practitioner appraisal is a 10-item instrument used by patients to assess doctors’ empathy. The aim of this study is to investigate the validity of the CARE measure in assessing medical students’ empathy during a formative family medicine clinical test. Method: All 158 final-year medical students were assessed by trained simulated patients (SPs) – who completed the CARE measure, the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE), and a global rating score to assess students’ empathy and history-taking ability. Results: Exploratory and confirmatory factor analysis identified a unidimensional structure. The CARE measure strongly correlated with both convergent measures: global rating (ρ=0.79 and <0.001) and JSPPPE (ρ=0.77 and <0.001) and weakly correlated with the divergent measure: history-taking score (ρ=0.28 and <0.001). Internal consistency was excellent (Cronbach’s α=0.94). Conclusion: The CARE measure had strong construct and internal reliability in a formative, undergraduate family medicine examination. Its role in higher stakes examinations and other educational settings should be explored.published_or_final_versio

Association of Hemoglobin A1c Levels With Cardiovascular Disease and Mortality in Chinese Patients With Diabetes

LettersAmong diabetic patients, hemoglobin A1c (HbA1c) is an important indicator of glycemic control and, together with blood pressure and cholesterol, is an indicator for risk of complications, including cardiovascular disease (CVD) and mortality. At present, there is no universal consensus on the optimal HbA1c level. Despite this, most international guidelines include a recommended HbA1c target range or level as a treatment goal. Several studies have identified a J-shaped curvilinear relationship between HbA1c and CVD incidence and all-cause mortality, but such a relationship has not yet been confirmed in a Chinese population. There are substantial differences in disease risks across racial and ethnic groups due to genetic and environmental factors including life-style and health behaviors, and thus, previous results from Western studies may not be transferable to a Chinese population. We sought to examine the association among mean HbA1c, CVD events, and mortality among Chinese primary care patients with type 2 diabetes mellitus (T2DM) in Hong Kong.postprin