Effects of SARS on consultations in primary care in Hong Kong

Objective: To study the infection control measures and concerns in primary care practices, and the effects of SARS on primary care consultation using the Leicester Assessment Package (LAP) criteria during the SARS episode in Hong Kong. Design: A postal survey using a questionnaire. The questionnaire consisted of three parts on the demographic data, infection control precautions taken and concerns of the respondents, and the effect of SARS on consultations. Subjects: Full members and fellows of the HKCFP. Main outcome measures: Infection control precautions including performance of initial screening/triage, by whom and how these were carried out, actions for the triaged patients, use of personal protection equipments (PPE), organisation and format of infection control training of staff and decontamination practice; perceptions of adequacy of protection and areas of concern; and proportion and degree to which consultation skills were affected using the LAP criteria. Results: The response rate was 60%. 71.4% respondents triaged their patients. 85.9% took temperatures of their patients. All respondents wore a mask during consultations. 69.8% organised training for their staff and clinic. Most respondents regularly decontaminated their clinic. 56% felt adequately protected by their infection control precautions and use of PPE but 44% did not. The major concerns were the variable clinical presentations of SARS, the practicability of wearing full protection, and the lack of early and reliable diagnostic tests. The type of practice was found to be a factor affecting the choice of infection control precautions. Consultation skills were found to be affected in ≤ 25% of consultations. History taking, physical examination, management and problem solving were found to be more difficult but relationship with patients and anticipatory care became easier. Conclusion: Choice of infection control precautions was related to the type of practice. The major concerns of primary care physicians were the variable clinical presentations of SARS and the lack of early and reliable diagnostic tests. Consultation skills were affected in ≤ 25% of consultations but patients were found to be more receptive to anticipatory care.published_or_final_versio

Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population

<p>Abstract</p> <p>Background</p> <p>In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM) started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD) challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD) status, and the choice of TCM and western medicine (WM) services in the Hong Kong population.</p> <p>Methods</p> <p>This study is a secondary analysis of the Thematic Household Survey (THS) 2005 dataset. The THS is a Hong Kong population representative face to face survey was conducted by the Hong Kong Administrative Region Government of China. A random sample of respondents aged >15 years were invited to report their use of TCM and WM in the past year, together with other health and demographic information. A total of 33,263 persons were interviewed (response rate 79.2%).</p> <p>Results</p> <p>Amongst those who received outpatient services in the past year (n = 18,087), 80.23% only visited WM doctors, 3.17% consulted TCM practitioners solely, and 16.60% used both type of services (double consulters). Compared to those who only consulted WM doctor, multinomial logistic regression showed that double consulters were more likely to be older, female, NCD patients, and have higher socioeconomic backgrounds. Further analysis showed that the association between age and double consulting was curvilinear (inverted U shaped) regardless of NCD status. Middle aged (45-60 years) NCD patients, and the NCD free "young old" group (60-75 years) were most likely to double consult. On the other hand, the relationship between age and use of TCM as an alternative to WM was linear regardless of NCD status. The NCD free segment of the population was more inclined to use TCM alone as they become older.</p> <p>Conclusion</p> <p>In Hong Kong, most patients have chosen WM provided in the public sector as their sole outpatient service provider for NCD. Amongst TCM service users, middle aged NCD patients are more likely to choose both TCM and WM outpatient services. Meanwhile, older people without NCD are more likely to use TCM as their main form of care, but the size of this population group is small. These utilization patterns show that patients choose both modalities to manage their NCD and TCM should be considered within policies for supporting patients with NCD under the wider primary health and social care system that supports patient choice.</p