Patient presentation and physician management of upper respiratory tract infections: A retrospective review of over 5 million primary clinic consultations in Hong Kong

Background: Upper respiratory tract infection (URTI) has a significant healthcare burden worldwide. Considerable resources are consumed through health care consultations and prescribed treatment, despite evidence for little or no effect on recovery. Patterns of consultations and care including use of symptomatic medications and antibiotics for upper respiratory tract infections are poorly described. Methods. We performed a retrospective review of computerized clinical data on patients presenting to all public primary care clinics in Hong Kong with symptoms of respiratory tract infections. International Classification of Primary care (ICPC)codes used to identify patients included otitis media (H71), streptococcal pharyngitis (R72), acute URTI (R74), acute sinusitis (R75), acute tonsillitis (R76), acute laryngitis (R77), and influenza (R80). Sociodemographic variables such as gender, age, chronic illness status, attendance date, type and duration of drug prescribed were also collected. Results: Of the 5,529,755 primary care consultations for respiratory symptoms from 2005 to 2010, 98% resulted in a prescription. Prescription patterns of symptomatic medication were largely similar across the 5 years. In 2010 the mean number of drugs prescribed per consultation was 3.2, of which the commonly prescribed medication were sedating antihistamines (79.9%), analgesia (58.9%), throat lozenges (40.4%) and expectorant cough syrup (33.8%). During the study period, there was an overall decline in antibiotic prescription (8.1% to 5.1%). However, in consultations where the given diagnosis was otitis media (H71), streptococcal pharyngitis (R72), acute sinusitis (R75) or acute laryngitis (R76), over 90% resulted in antibiotic prescription. Conclusion: There was a decline in overall antibiotic prescription over the study period. However, the use of antibiotics was high in some conditions e.g. otitis media and acute laryngitis a. Multiple symptomatic medications were given for upper respiratory tract infections. Further research is needed to develop clinical and patients directed interventions to reduce the number of prescriptions of symptomatic medications and antibiotics that could reduce costs for health care services and iatrogenic risk to patients. © 2014 Kung et al.; licensee BioMed Central Ltd.link_to_subscribed_fulltex

Family medicine training in Hong Kong's public health care system: A focus group study

Objective: General Outpatient Clinics (GOPCs) now provide the main bulk of basic community training for Family Medicine (FM) trainees. Although it is obvious that there is a rising number of FM trained doctors, there still remains a significant proportion of the GOPC workforce who have not been through any formal vocational training. With the increasing role of FM in Hong Kong's healthcare, the Chinese University of Hong Kong (CUHK) and the Hospital Authority conducted a joint project to review and define the role of GOPCs and FM training that can facilitate primary care development for the whole of Hong Kong and provide a robust community based medical service affordable to all. Thus, focus groups were formed to study and form part of the whole project which looked at FM training provision within the GOPC setting. Design: Focus group discussions. Subjects: Basic and higher FM trainees, doctors with no formal vocational FM training, and FM specialists working in the GOPCs. Main outcome measures: The discussions were based on several main themes, including current training modalities, current strengths and weaknesses of GOPC as a location for FM training, FM competency achievement and future training opportunities for FM trainees working in GOPCs. Results: Discussions from four focus groups consisting of a total of 34 doctors were reviewed. Themes emerging from the focus groups: large variation in training modalities, discrepancy between College requirements and GOPC practice, changing patient variety within the GOPC setting, manpower and resource limitations, time constraint and protected time for training. Conclusion: Findings from this study highlighted a gap between the Hong Kong College of Family Physicians (HKCFP) and GOPC in terms of training provision. Furthermore, trainees do not have a consistent view of FM qualities and competencies. Collaborations between the HKCFP and HA would be essential so that training provision and requirements are in line with each other. Changes will also need to take place at the GOPC level in order to improve the quality of training. Opportunities for non-GOPC training should be explored, including collaboration with hospital specialists and private doctors. It may be necessary to form a working group that incorporates these different parties so that the different ideas can be intertwined.link_to_subscribed_fulltex

Family medicine internship training: Importance for Hong Kong's primary care

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Impacts of alcohol duty reductions on cardiovascular mortality among elderly Chinese: A 10-year time series analysis

Background: In March 2007, the Hong Kong Government halved its heavy excise taxes on beer and wine, and 1 year later, it eliminated all duties on these beverages. This study examines the impact of such duty reductions on cardiovascular disease (CVD)-related mortality among the elderly in Hong Kong. Methods: Box-Jenkins autoregressive integrated moving average intervention time series analyses were applied to monthly morality data from 2001 to 2010 to quantify the impacts of duty reduction and exemption on CVD death rates among those aged 65 years or older. Results: The alcohol duty reduction in March 2007 was associated with an estimated 13% increase (95% CI 2% to 24%) in CVD death rates among elderly men, after controlling for the other intervention, outlier, trends and seasonal variations. This was equivalent to an extra 11 CVD deaths per 100 000 elderly men each month. Much of the observed impacts on CVD death rates were found to have contributed only by that on ischaemic heart disease mortality (18% increase in rate for men (95% CI 4% to 34%); 15% increase for women (95% CI 0.4% to 31%)), not by mortality due to stroke or hypertension. The alcohol duty exemption on March 2008 was not found to have impacted the CVD death rates. Conclusions: The increase in CVD death rates among the Chinese elderly after alcohol duty reduction suggest that the purported beneficial effect of moderate alcohol use may not apply to certain Chinese populations, adding fuel to the ongoing debate on the risks and benefits of moderate alcohol consumption on mortality.link_to_subscribed_fulltex

Effect of facemasks on empathy and relational continuity: A randomised controlled trial in primary care

Background: There is limited evidence to support the use of facemasks in preventing infection for primary care professionals. Negative effects on communication has been suggested when the physician wears a facemask. As communication skills and doctor patient relationship are essential to primary care consultations, the effects of doctor's facemask wearing were explored. Method. A randomised controlled study was conducted in primary care to explore the effects of doctors wearing facemasks on patients' perception of doctors' empathy, patient enablement and patient satisfaction. Primary care doctors were randomized to mask wearing and non mask wearing clinical consultations in public primary care clinics in Hong Kong. Patients' views were gathered using the Consultation and Relational Empathy (CARE) Measure, Patient Enablement Instrument (PEI) and an overall satisfaction rating scale. The effects of face mask wearing were investigated using multilevel (hierarchical) modelling. Results: 1,030 patients were randomised to doctor-mask wearing consultations (n = 514) and non mask wearing consultations (n = 516). A significant and negative effect was found in the patients' perception of the doctors' empathy (CARE score reduction -0.98, p-value = 0.04). In the more established doctor-patient relationship, the effect of doctors' mask wearing was more pronounced (CARE score reduction -5.67, p-value = 0.03). Conclusion: This study demonstrates that when doctors wearing a facemask during consultations, this has a significant negative impact on the patient's perceived empathy and diminish the positive effects of relational continuity. Consideration should be taken in planning appropriate use of facemasks in infectious disease policy for primary care and other healthcare professionals at a national, local or practice level. Clinical trial registration. This trial was registered on Chinese Clinical Trial Register (ChiCTR). Registration no.: ChiCTR-TTRCC-12002519. URL: http://www.chictr.org/ en/proj/show.aspx?proj=3486. Due to administrative error, registration of trial did not take place until after the trial started on 1st August 2011 and registration number was released on 21st September 2012. © 2013 Wong et al.; licensee BioMed Central Ltd.link_to_subscribed_fulltex