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

Research fund for the control of infectious diseases: commissioned studies

Research Fund for the Control of Infectious Diseases: Research Dissemination Reportspublished_or_final_versio

Projecting ischaemic heart disease mortality and morbidity in Hong Kong

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Summary of research projects supported by the Health Services Research Fund (HSRF) and the Health Care and Promotion Fund (HCPF)

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Hong Kong domestic health spending: Financial years 1989/90 to 2009/10

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Non-traditional biomarkers in the prediction of cardiovascular events among Chinese

Poster PresentationINTRODUCTION: Biomarkers of subclinical systemic chronic inflammation are increasingly recognised as a key player in atherosclerosis. C-reactive protein, measured using high-sensitivity assay (hsCRP), is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). As obesity is associated with disregulated expression of various adipokines, either pro-inflammatory or anti-inflammatory, such adipokines may also serve as non-traditional biomarkers for the accelerated atherosclerosis associated with obesity. In this prospective cohort study, we examined the predictive value of a variety of non-traditional biomarkers for CVD among Hong Kong Chinese, and determined if they would …published_or_final_versionThe 17th Medical Research Conference, The University of Hong Kong, Hong Kong, 14 January 2012. In Hong Kong Medical Journal, 2012, v. 18 suppl. 1, p. 20, abstract no. 2

Hong Kong domestic health spending: financial years 1989/90 to 2005/06

This report presents the latest estimates of Hong Kong domestic health spending between fiscal years 1989/90 and 2005/06, cross-stratified and categorised by financing source, provider, and function on an annual basis. In fiscal year 2005/06, total health expenditure was HK$71 557 million. In real terms, it grew 6.5$71 557 million total health expenditure in 2005/06, HK$68 810 million (96.2$2746 million (3.8%) on capital expenses (ie investment in medical facilities). Services of curative care accounted for the largest share (67.3%) and were made up of ambulatory services (35.7%), in-patient services (27.7%), day patient hospital services (3.4%), and home care (0.6%). The second largest share was spending on medical goods outside the patient care setting (10.8%). In terms of health care providers, hospitals (44.0%) accounted for the largest share of total health expenditure in 2005/06, followed by providers of ambulatory health care (31.4%). We observed a system-wide trend towards service consolidation at institutions (as opposed to free-standing ambulatory clinics, most of which are staffed by solo practitioners). Not taking capital expenses (ie investment in medical facilities) into account, public current expenditure on health amounted to HK$34 849 million (50.6$33 961 million) was mostly incurred at providers of ambulatory health care (55.8%). This reflects the mixed health care economy of Hong Kong, where public hospitals generally account for about 90% of total bed-days and private doctors (including western and Chinese medicine practitioners) provide about 70% of out-patient care. Although both public and private spending were mostly expended on personal health care services and goods (93.0%), the patterns of distribution among functional categories differed. Public expenditure was targeted at in-patient care (53.7%) and substantially less on out-patient care (24.6%), especially low-intensity first-contact care. In comparison, private spending was concentrated on out-patient care (49.9%), followed by medical goods outside the patient care setting (22.0%) and in-patient care (19.0%). Compared to countries of the Organisation for Economic Co-operation and Development, Hong Kong has devoted a relatively low percentage of gross domestic product on health services in the last decade. As a share of total spending, public funding (either general government revenue or social security funds) was also lower than in most comparably developed economies, although commensurate with its public revenue collection base.published_or_final_versio

High-sensitivity C-reactive protein and other inflammatory markers in predicting cardiovascular risk in Hong Kong Chinese

Poster PresentationINTRODUCTION: Inflammation is increasingly recognised as a key player in atherosclerosis, and C-reactive protein measured using high-sensitivity assay (hsCRP) is the most promising inflammatory marker in predicting the risk of cardiovascular diseases (CVD). In this prospective cohort study, we examined the predictive value of hsCRP for CVD in Hong Kong Chinese and determined if other biomarkers would enhance the predictive value of hsCRP. METHODS: Subjects were recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study …published_or_final_versionThe 16th Medical Research Conference, The University of Hong Kong, Hong Kong, 22 January 2011. In Hong Kong Medical Journal, 2011, v. 17 suppl. 1, p. 66, abstract no. 11

Domestic health expenditure in Hong Kong: 1989/90 to 2001/02

Objective. To estimate the total domestic health expenditure in Hong Kong between fiscal years 1989/90 and 2001/02, with breakdown by financing source, provider, and function over time. Methods. The standard health accounting methods as per the Organisation for Economic Co-operation and Development System of Health Accounts guidelines of 2000 were adopted. Results. Total domestic health expenditure was $68 620 million in the fiscal year 2001/02. In real terms, expenditure grew at an average rate of 7% while gross domestic product increased by 4% during the same period. This indicates a growing share of health spending relative to gross domestic product, from 3.8% in 1989/90 to 5.5% in 2001/02. This upward trend was largely driven by increased public spending that rose 208% in real terms over the period, compared with 76% for private spending. Out-of-pocket payments by households accounted for about 70% of private spending while employers and insurance accounted for 28%. Private insurance plays an increasingly important role in financing private spending whereas household expenditure has shown a corresponding decrease during the period. Expenditure incurred at providers of ambulatory services and hospitals accounted for more than 70% of total health expenditure during the observed period. Hospitals' share of total spending increased by 18%, reaching 45% of total expenditure in 2001/02, whilst the share of providers of ambulatory services reduced to 30% in 2001/02. The two largest functional components of total health expenditure were ambulatory care (35-41%) and in-patient curative care (20-27%). Public spending generally financed in-patient curative care and ambulatory services; private spending was concentrated on ambulatory services and medical goods outside the patient care setting. Conclusion. These data provide important information for the public, policymakers, and researchers to assess the performance of the health care system longitudinally, and to evaluate health expenditure-related policies.published_or_final_versio

Hong Kong domestic health spending: Financial years 1989/90 to 2008/09

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