Primary Care and Primary Care Directory: for primary care providers
Primary care is the first point of contact for individuals and families in a continuing healthcare process.
A good primary care system provides the public with access to better care which is comprehensive, holistic, co-ordinated and as close as possible to where people live and work. Primary care provides preventive care as well as quality management of diseases to everyone which is important for promoting health of the population. Evidence demonstrates that health systems that rely more on primary care in comparison with systems based on specialist care produce better population health outcomes, reduce the rate of avoidable mortality, improve continuity and access to healthcare, result in higher patient satisfaction, and reduce health-related disparities at a lower overall cost for healthcare.
Primary care contributes to the health of the population and covers a wide range of services which includes the delivery and provision of:
- health promotion;
- prevention of acute and chronic diseases;
- health risk assessment and disease identification;
- treatment and care for acute and chronic diseases;
- self-management support; and
- rehabilitative, supportive and palliative care for disability or end-stage diseases.
Primary care providers
With the rise in chronic disease burden, population ageing and rapid development of knowledge and technologies, it becomes increasingly difficult for a medical practitioner or healthcare professional to provide the whole range of functions of primary care to individual patients. Comprehensive management of chronic diseases or patients with associated co-morbidities often requires treatment and support provided by a multi-disciplinary team of primary care professionals.
In addition to western medicine practitioners, other healthcare professionals also play an important role in providing primary care, either as practitioners (e.g. dentists, Chinese medicine practitioners) or as members of primary care teams (nurses, allied health professionals and other healthcare service providers). All providers should share the core principles of family medicine in adopting a holistic, continuing and comprehensive approach for the provision of an integrated quality primary care.
Strategies for Development of Primary Care in Hong Kong
Primary care development in the global perspective
At the International Conference on Primary Health Care in Alma Ata more than 30 years ago, a visionary declaration that primary care was the key to "Health for All' was made. This set the scene for international efforts to promote primary care and formally acknowledged the pivotal role of a strong primary care system. Many countries striving to develop or strengthen their primary care systems recognise the key role of primary care as the foundation of effective healthcare systems. The need to enhance primary care was once again reaffirmed in the World Health Report 2008 - Primary Health Care: Now More Than Ever, and was further stressed by the 2009 World Health Assembly's resolution on primary care policies. The "Western Pacific Regional Strategy for Health Systems Based on the Values of Primary Health Care" published by WHO in 2010 states that the values of primary health care to be considered for health systems include equity, social justice, universality, people-centredness, community protection, participation, scientific soundness, personal responsibility, self-determination and self-reliance.
Development of primary care in Hong Kong
In Hong Kong, the Government has taken steps to improve primary care in the public system since 1990. After reviewing the service delivery model for the health system, the Government put forward a comprehensive package of interrelated proposals for reforming the healthcare system in the consultation document "Your Health, Your Life" in 2008. Emphasis was placed on enhancing primary care.
The major strategies to strengthen primary care in Hong Kong should target at improving the attributes of a good primary care system, supported by a well-equipped primary care workforce and built-in infrastructure.
As such, we need to -
- Develop comprehensive care by multi-disciplinary teams
- Improve continuity of care for individuals
- Improve co-ordination of care among healthcare professionals across different sectors
- Strengthen preventive approach to tackle major disease burden
- Enhance inter-sectoral collaboration to improve the availability of quality care, especially care for chronic disease patients
- Emphasise person-centred care and patient empowerment
- Support professional development and quality improvement
- Strengthen organisational and infrastructural support for the changes
What is the Primary Care Directory?
Primary Care Directory ("the Directory") is a web-based system containing personal and practice-based information of different primary care providers. Public can use the search function to choose the primary care providers who most suit them. A multi-disciplinary team is central to the provision of more comprehensive primary care, as such, the Directory will consist of sub-directories for different healthcare professionals providing primary care. In the initial stage, we have established the sub-directories of doctors and dentists. Sub-directories for other professionals, like Chinese medicine practitioners, nurses and allied health professionals will be developed in a later stage.
Why should I join the Directory?
The Directory provides information to the public so that they can choose their own family doctor or dentist according to their own needs.
It also serves as a platform for different healthcare poviders to work as a multi-disciplinary team so as to provide the public with more comprehensive services.
Your enrolment and commitment to provide directly accessible, comprehensive, continuing, and co-ordinated person-centred primary care services are needed.
What are views of the public about a family doctor?
Recent surveys show that most of the public are aware of the concept of family doctor. However, a significant proportion of the population does not have a family doctor nor perceive the need of having one. Many people do not recognise the role of the family doctor in the care of chronic diseases. Besides, some people regard having a family doctor as being luxurious. There are some additional findings in the surveys on the views and expectations of the public on family doctors. These include:
- Family doctors should provide detailed explanation of their medical conditions.
- Family doctors should provide preventive care and screemng.
- They prefer a doctor who knows clearly their physical conditions, who can provide fast-acting and effective treatment and also has a friendly and sincere attitude.
- Cost, consistency, informational continuity, prescription duration, quality of care, trust, access to specialists and allied healthcare professionals, tests and investigations are factors which affect the patients' choice of healthcare for their chronic diseases.
- Family doctors should receive formal training.
What Can a Family Doctor Do?
A Family Doctor cares about patients beyond the treatment of their diseases.
He is capable of providing comprehensive, continuing, whole person and preventive care to an individual and family in their own community or environment so as to ensure physical, psychological and social well-being for his patients.
As part of the multi-disciplinary care team, he also co-ordinates the care provided by other healthcare professionals.
The core competencies of a family doctor could be best visualised in the branches of the Wonca Tree (as shown) which symbolise primary care based on:
- strong roots of science, professional approach and the healthcare context ;
- strong trunk making up by clinical tasks, patient doctor communications and practice management.
A Family Doctor is the core of the primary care and his attributes could breathe life to the primary care system so that the branches bear leaves and fruit !
Your First Contact with Healthcase Service - Family Doctor
...A lifelong partner for the patient
Family doctor carries the ongoing responsibility of caring for his patient and family. He should develop a continuing therapeutic relationship with patients gaining their confidence. This invaluable doctor-patient relationship and trust could enable the family doctor to provide a better co-ordinated and effective healthcare service to his patients.It also minimises confusion due to miscommunication. Patients are therefore cared according to their changing needs and health conditions over the course of their life.
Mrs. EF was in her early forties and a mother of two girls. She has been seeing Dr. X since her early twenties due to some episodic diseases. After marriage, she consulted Dr. X for contraceptive advice and regular cervical smear screening. Mr. EF and their daughters were also visiting Dr.X for episodic illnesses and consultation of health issues Dr. X has been advising Mrs. EF on breast awareness as she had a family history of breast cancer. Recently, Mrs. EF noticed a small lump on her breast and consulted Dr. X for advice. He made an urgent referral to a public hospital for Mrs. EF when he confirmed she had a 2cm breast lump on physical examination. Stage | carcinoma of the breast was confirmed after investigations and it was excised subsequently. Mr. and Mrs. EF suffered from a lot of stress in the process of diagnosis and treatment of the disease, which they refused to tell their families and friends. Dr. X became the only one they could trust. The couple concerned if Mrs. EF could still get pregnant as they wanted to have a boy. They expressed their worries to Dr X who offered psychological support to the couple in the process and explained to them the malignancy would not affect the chance of pregnancy in future. They were reassured and happy that they could share such personal issues with their family doctor.
... As a co-ordinator in the multi-disciplinary care of chronic illnesses
Mr. GH was a 65 year-old gentleman recently diagnosed to have diabetes mellitus by Dr Y. Mr. GH has been a smoker for 40 years and was obese. Dr. Y managed Mr. GH's problems by advising him on lifestyle modifications and prescribing oral hypoglycaemic agents according to updated reference frameworks. Dr.Y referred Mr. GH to see a private dietitian for diabetic and weight reduction dietary advice. He also arranged a session for Mr. GH to screen for diabetic retinopathy and foot problem in a non-government organisation (NGO). Mr. GH was also referred to the smoking cessation service run by the Department of Health. Dr. Y followed up Mr GH tor his glycaemic control. his progress on weight reduction and smoking cessation. He also reviewed the complications screening report from the NGO and explained to Mr. GH that it needed to be done annually. Dr. Y formulated long-term management plans in collaboration with Mr. GH. He was now able to keep a food diary, achieve a good glycaemic control with regular blood sugar monitoring, adopt regular exercise and reduce his body weight. Both Mr. GH and Dr.Y were happy about the progress .
In taking care of patients with chronic illnesses, a multi-disciplinary co-ordinated service is needed. Primary care doctors should serve as a co-ordinator inthe process of supporting patients with progressive or complex long-term conditions which require input from nursing and allied health professionals. This will help to reduce disease complications and improve health outcomes. Better co-ordinated care also minimises service duplication and helps patients receive the optimal care based on their needs.
COMPREHENSIVE & PERSON-CENTRED
... Caring the patient in the context of bio-psychosocial model
Ms. AB is a 38 years old new immigrant who just arrived Hong Kong three months ago. She presented with bothersome chest discomfort in recent one month and expressed concern of heart attack. Assessment and investigations could not f ind out any organic cause for her chest discomfort. Upon further exploration by Dr Z, it was found that Ms. AB experienced great difficulties in adapting to the new environment with little family support in looking after her two small kids. Utilising the knowledge and trust engendered by repeated contacts, Dr. Z was able to reassure Ms. AB and relieve her worries about heart attack. Ms. AB subsequently understood and appreciated the nature of her suffering and collaborated with Dr. Z in seeking support from community resources. Ms. AB finally overcame her disabling illness and led a happy life with her family.
The family doctor embraces continuity and comprehensiveness and places emphasis on the patient's perspective within the context of family and community and these principles are embodied within the concept of the patientcentered care model.
... Every contact is an opportunity for prevention and health education
Apart from providing possible solutions in sickness, a family doctor aims also to maintain health. He is dedicated to exercise professional role by promoting health, modifying health risk factors and preventing diseases for the long-term health benefits of the patient.
Mr. CD is a 55 years old taxi driver who rarely sees any doctors over the last five years. He sustained a neck sprain injury in a road traffic accident and subsequently sought medical advice at a private clinic. Upon assessment, Dr. X noticed that Mr. CD was a smoker and his parents were both suffering from hypertension . Dr. X then performed an assessment in this first encounter and identified additional risk factors from Mr.CD, i.e. obesity with a Body Mass Index (BMI) of 30kg/m2, high blood pressure of 180/100mmHg and physical inactivity. Hypertension was confirmed in the subsequent visit and was associated with left ventricular hypertrophy. Dr. X formulated the management plan in collaboration with Mr. CD and engaged him in setting various treatment targets. Mr. CD finally quitted smoking and achieved optimal control of his blood pressure and body weight.
Primary Care Dentist- Not Only a Family Dentist
... A lifelong dentist
Mrs. JK was 28 years old and was 4 months pregnant. She has a 3 years old daughter named GG. She first visited Dr. K, a private dentist who was looking after her parents, when she was 12 years old. She told Dr. K that she did not want to smile because of her crooked teeth. Dr. K referred her to an orthodontist for consultation and treatment. He also reviewed her regularly and taught her tooth brushing and flossing techniques. After 2 years of orthodontic treatment, Mrs. JK's appearance improved and she regained her self confidence. When she was studying in university, Mrs. JK was frequently disturbed by pain and swelling associated with eruption of her wisdom teeth especially during examination periods. Dr. K took an x-ray and confirmed that two of her wisdom teeth were impacted and would not erupt normally. He removed both impacted teeth for her during her summer holidays. Due to the regular check-up and preventive care provided by Dr. K, Mrs. JK did not have any dental caries (decay) or periodontal (gum) problem until her first pregnancy. When she was expecting her first baby GG, she consulted Dr. K because of gum bleeding. On examination, red swollen gum and dental caries on two molar teeth were found. Dr. K reassured her that the periodontal problem was related to hormonal changes during pregnancy and dental caries developed because she was frequently eating sweet and sour snacks. Her oral condition was improved after restoration of the carious teeth and periodontal treatment by Dr. K. When Mrs. JK was expecting her second baby, she paid more attention to maintaining good oral hygiene habits by tooth brushing with fluoride toothpaste twice a day, flossing and adopting a good dietary habit by reducing snacking frequency to lower the risk of dental caries. In addition, Dr. K also gave Mrs. JK many valuable oral health advices to prevent her baby daughter GG from having early childhood caries. She did not let GG sleep with a milk bottle in her mouth and she brought GG to see Dr. K for annual check-up since her first birthday. GG was always happy to meet Dr. K and enjoyed her fun ride on the dental chair. Dr. K is the dentist that Mrs. JK and her family ever trust.
Good family dentists take a personal interest in the health of their patients and their family. They are preventionoriented and spend time giving approptiate evidence-based oral health education to their patients. They encourage regular dental check-ups for early detection of dental diseases. They also make timely referrals to other specialists where approptiate.They participate actively in continuing education and professional development to keep abreast of advances in science, technology, equipments and materials.
... A healthcare co-ordinator in the community
"Total patient care" is not only about curing and managing patients' disease but caring about their physical,mental and emotional well being. It is a co-operative multi-disciplinary team approach to treating each patient's special needs. Dental practitioners are privileged to be a member of a team of professionals to whom patients entrust for a lifetime of optimal health. Patients value the care as a positive factor contributing to their enjoyment of life.
Mr. LM was 58 years old. He was a smoker of over 20 years. He went to see Dr. H, a private dentist, because of discoloured, painful and slightly mobile teeth. His wife also complained that he had bad breath and his front teeth were growing longer. On examination, it was found that he had tobacco staining, calculus covering most of his teeth and moderate periodontal (gum) disease. Dr. H told him that gum recession of his front teeth made them looked longer. Dr. H reassured him that the periodontal condition would be improved by scaling (professional cleaning) to remove the calculus, good oral hygiene habits and by quitting smoking. To help Mr. LM in quitting smoking, Dr. H encouraged him to call a Smoking Cessation Hotline. Together with Dr. H's professional dental care and his own determination to improve oral hygiene by adopting good tooth brushing and flossing habits, his problem of bad breath was resolved. However, his periodontal condition with redness and swelling of the gum was not totally resolved. Dr. H suspected that the periodontal healing process might be affected by some systemic diseases. He referred Mr. LM for further investigation by his family doctor Dr. J and a diagnosis of diabetes mellitus was made. It was the lowering of body resistance towards bacterial infection that lowered the healing capability of the periodontal tissue. Dr. J gave Mr. LM dietary advice and prescribed medication to control his diabetes. Dr. H continued with the periodontal treatment and Mr. LM's periodontal condition finally improved. Dr. H recalled Mr. LM biannually to monitor his periodontal health.
How to Enrol in the Primary Care Directory?
- To enrol in the Primary Care Directory, primary care providers need to complete the enrolment procedures online.
- Personal particulars together with the professional registration information will be validated with the respective professional Boards and Councils.
- You may enrol through the following website: http://www.pcdirectory.gov.hk
- For enquiries, please contact the Primary Care Office of the Department of Health.
(Phone: 852-3576 3658, Fax: 852-3583 4549, E-mail: email@example.com)
What is my role if I have joined the Directory?
- To commit yourself to the provision of directly accessible, comprehensive, continuing, and co-ordinated person-centred primary care services to the public.
- To demonstrate that you are pursuing continuing medical education or continuing professional development in order to uphold and improve the quality of service