Community-based service system to enhance primary healthcare in HK

A community-based system that delivers accessible and coherent primary healthcare services in a sustainable manner will be part of the healthcare reform to be undertaken by the government to improve overall health and quality of life of the population of Hong Kong.

Reforms set out under the Primary Healthcare Blueprint emphasize the concept of “family doctor for all” in chronic disease management, as well as consolidation of primary healthcare services in the community through service coordination, strategic purchasing and medical-social collaboration. [https://www.primaryhealthcare.gov.hk/]

Family doctor for all

The Hong Kong College of Family Physicians (HKCFP) welcomes the promotion of the “family doctor for all” concept. “Everyone should have a family doctor for accessible, long-term and comprehensive care,” said Dr David Chao, President of HKCFP, at a recent media event hosted by the Hong Kong Academy of Medicine (HKAM).

“The concept of ‘family doctor for all’ not only strengthens the relationship between patients and doctors, but also enables patients to seek appropriate consultations when necessary,” suggested Dr Fei-Chau Pang, President of the Hong Kong College of Community Medicine and Commissioner for Primary Healthcare of the Health Bureau, at the HKAM media event.

Chronic Disease Co-Care Pilot Scheme

This year, a 3-year Chronic Disease Co-Care Pilot Scheme will be launched to coordinate and subsidize local and professional support for patients to obtain medical care and lifestyle interventions from family doctors and District Health Centres. [Hong Kong Med J 2023;29:1-2]

Through community networks, individuals will be matched with family doctors in the formalized Primary Care Directory (PCD), which is to be linked to subsidized services, such as Elderly Health Care Vouchers, vaccination, cancer screening and chronic disease management. The Chronic Disease Co-Care Pilot Scheme will allow patient-doctor matching and improve screening and diagnosis of hypertension, prediabetes and early-stage diabetes.

“Hypertension and diabetes are found in 60 percent of patients who receive care at public hospitals and clinics in Hong Kong,” Pang noted. However, the Department of Health’s Population Health Survey 2014/15 showed that about half of the patients with hypertension or diabetes were unaware of their condition before diagnosis. [https://www.chp.gov.hk/en/static/51256.html] Globally, 5–10 percent of individuals with prediabetes may develop diabetes each year. [Lancet 2012;379:2279-2290]

“Diabetes is associated with various complications, including renal disease, diabetic neuropathy, and cardiac and peripheral artery diseases, which require specialist care,” said Professor Philip Li, Vice President of HKAM. [Nat Rev Endocrinol 2022;18:525-539] “In many countries and regions, including Hong Kong, >60 percent of patients who start dialysis have diabetes. The community-based [partnership for] chronic disease management under the Chronic Disease Co-Care Pilot Scheme may help reduce the burden [on speciality care services].”

Achieving healthcare reform: Training and education

“The healthcare reform needs full support of healthcare professionals to build trust with the community and maintain high quality of care,” Pang pointed out. “The Primary Healthcare Commission will collaborate with HKAM to advance service standards. [For example,] with the formalized PCD, we will develop requirements for both enrolment in the new directory and specification of regular training programmes.”

“We need ≥3,750 qualified family doctors to maintain quality primary care, and ≥100 medical graduates to undertake training in family medicine each year,” Chao said. “For practising doctors, HKCFP provides continuing medical education programmes and training courses in family medicine. We encourage general practitioners to participate in these programmes and courses.”