Authors (including presenting author) :
Li WS, Ho KM, Hui LC, Yip PC, Chan TC, Kan CF, Au WH, Li YC
Affiliation :
KCC FM&GOPC
Introduction :
Long waiting times for specialist outpatient clinics have been a significant concern in the public healthcare of Hong Kong. To address this issue, a new collaboration was established between KCC Family Medicine and QEH Urology with the primary objective of shortening the waiting time for urology specialist outpatient clinic (SOPC) appointments.
Objectives :
This study presents the outcomes of this collaboration, focusing on the implementation of tools prepared by urologists to aid family medicine doctors in managing renal cysts and microscopic haematuria cases.
Methodology :
The collaboration resulted in the set up of Family Medicine Specialist Clinic Urology (FMSC Uro), which commenced its services in June 2023. Routine new cases of renal cysts and microscopic haematuria were triaged by urologist to be seen at FMSC Uro. Family medicine doctors at the clinic utilized guidelines prepared by QEH urologists based on the European Association of Urology recommendations. The guidelines included the use of the Bosniak classification for renal cysts based on ultrasound or CT findings, and a risk assessment table for microscopic haematuria. These tools helped family medicine doctors’ triage and manage cases effectively.
Result & Outcome :
From June 16, 2023, to March 1, 2024, a total of 92 cases were seen at the FMSC Uro. Throughout this period, 30 cases were closed, with 11 (36.7%) of them being referred back to urology for further assessment. Out of the 11 cases that were referred back, 7 cases with the diagnosis of Bosniak type II renal cyst, 1 case of Bosniak IIF, 2 cases of parapelvic cyst without hydronephrosis, and 1 case with right pelviureteric junction stricture with hydronephrosis. All 30 cases were closed within their second follow-up session, indicating efficient management within the family medicine setting for these two urology conditions.
The collaborative effort between KCC Family Medicine and QEH Urology in establishing the FMSC Uro has shown positive outcomes in reducing the patient load for urology SOPC. The FMSC Uro Clinic has successfully functioned as a one-stop service, providing comprehensive medical care to patients with not only the agreed conditions but also other health problems. Further study with a larger sample size and a longer follow-up period would help provide more robust evidence on its impact. As indicated in the initial trial phase of the clinic, over 80% of all refer back cases were benign conditions e.g. Bosniak II renal cyst and parapelvic cyst without hydronephrosis. With time and experience gained by both partners, guidelines can be refined, leading to further reduction in the refer back rate. Moreover, expanding the collaborative approach to include other urology conditions could potentially yield further benefits in reducing waiting times for Urology SOPC.
