Proposed Topic (Most preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Fung HT(1), Lai KPL(1), Wong SN(1), Luk MHM(1), Chan PF(1)
Affiliation :
(1)Department of Family Medicine and Primary Health Care, United Christian Hospital and Tseung Kwan O Hospital, Kowloon East Cluster(KEC)
Introduction :
Chronic respiratory diseases (CRD) such as asthma imposes a substantial burden on the public health system. Family physicians play an important role in managing CRD in primary care. Since the introduction of new CRD-related drugs including LABA/ICS and LAMA inhalers to General Out-patient Clinics (GOPCs) in July 2023, and with support from Nurse and Allied Health-Respiratory clinic (NAHC-RC), Family Medicine Specialist Clinic (FMSC) in KEC had started receiving referrals from GOPCs to manage patients with suboptimal control of asthma, despite using maximum tolerated dose of medications available in GOPCs, and to enhance our gatekeeping role.
Objectives :
1. To provide comprehensive clinical assessment and pharmacological treatment by Family Medicine Specialists according to evidence-based clinical guidelines.
2. To provide spirometry assessment and pulmonary rehabilitation by NAHC-RC.
Methodology :
Evidence-based clinical guideline on asthma was updated by our department in June 2023 and NAHC-respiratory disease service framework was updated by Co-ordinating Committee of Family Medicine in April 2023 respectively. Relevant clinical information of asthma patients referred to the FMSC from July 2023 to November 2023 was reviewed.
Result & Outcome :
12 patients with asthma were seen in the FMSC during the review period. Mean age of patients was 64.3 years old (range 37 to 78). 75% were female. 50% were diagnosed to have asthma clinically without any lung function test performed before. 75% had partially controlled to uncontrolled asthma and were using Global Initiative for Asthma (GINA) step 3 or 4 treatment. 25% had poor puff compliance and 16.7% had poor puff technique. 75% were referred to NAHC-RC for spirometry, education on puff technique and pulmonary rehabilitation. 58% were switched to new CRD related drugs. 16.7% were ex-smokers or current smokers, and were diagnosed to have asthma-chronic obstructive pulmonary disease overlap syndrome. All current smokers were offered referral to smoking counselling and cessation service.
Conclusion:
With the introduction of new CRD related drugs, evidence-based guidelines and support from NAHC-RC, a multi-disciplinary care approach in FMSC could effectively manage more complex asthma cases in primary care so as to reduce the need of referral to secondary care and risk of hospitalization.
