ObjectiveTo estimate the prevalence and severity of burnout and explore the factors associated with burnout among Hong Kong medical graduates up to 20 years post-graduation.DesignCross-sectional survey.SettingHong Kong.ParticipantsDoctors who graduated from the University of Hong Kong between 1995 and 2014.Primary and secondary outcome measuresBurnout as measured by the Copenhagen Burnout Inventory (CBI), alcohol consumption as measured by the Alcohol Use Disorders Identification Test Version C, lifestyle behaviours (hours of sleep and work, exercise, smoking, substance use), career satisfaction and sociodemographic characteristics were obtained using paper or online questionnaires.ResultsResponse rate was 30.9% (496/1607). Prevalence of CBI burnout was 63.1% (personal), 55.9% (work-related) and 35.4% (patient-related). The mean CBI subscale scores were 57.4±21.4 (personal), 48.9±7.4 (work-related) and 41.5±21.8 (client-related). Factors associated with personal and patient-related burnout included age (coeff −0.437, 95% CI −0.779 to −0.095 and coeff −0.596, 95% CI −0.965 to −0.228, respectively), practice setting (coeff −5.759, 95% CI −10.665 to −0.853 and coeff −5.317, 95% CI −10.602 to −0.032, respectively) and regular exercise (coeff −6.855, 95% CI −11.102 to −2.608 and coeff −6.769, 95% CI −11.333 to −2.205, respectively). Gender (coeff 5.1, 95% CI 1.382 to 8.818), average hours of sleep per night (coeff −5.200, 95% CI −7.139 to −3.262) and work hours per week (coeff 0.226, 95% CI 0.099 to 0.353) were associated with personal burnout only. No factors were significantly associated with work-related burnout.ConclusionBurnout is highly prevalent among Hong Kong medical graduates. Younger doctors, women and those working in the public sector appear to be at higher risk for burnout and may benefit from targeted interventions. Policymakers and healthcare authorities should consider measures to help reduce burnout by enabling adequate sleep, reducing work hours and encouraging exercise.

IntroductionThrough the INTernational ConsoRtium of Primary Care BIg Data Researchers (INTRePID), we compared the pandemic impact on the volume of primary care visits and uptake of virtual care in Australia, Canada, China, Norway, Singapore, South Korea, Sweden, the UK and the USA.MethodsVisit definitions were agreed on centrally, implemented locally across the various settings in INTRePID countries, and weekly visit counts were shared centrally for analysis. We evaluated the weekly rate of primary care physician visits during 2019 and 2020. Rate ratios (RRs) of total weekly visit volume and the proportion of weekly visits that were virtual in the pandemic period in 2020 compared with the same prepandemic period in 2019 were calculated.ResultsIn 2019 and 2020, there were 80 889 386 primary care physician visits across INTRePID. During the pandemic, average weekly visit volume dropped in China, Singapore, South Korea, and the USA but was stable overall in Australia (RR 0.98 (95% CI 0.92 to 1.05, p=0.59)), Canada (RR 0.96 (95% CI 0.89 to 1.03, p=0.24)), Norway (RR 1.01 (95% CI 0.88 to 1.17, p=0.85)), Sweden (RR 0.91 (95% CI 0.79 to 1.06, p=0.22)) and the UK (RR 0.86 (95% CI 0.72 to 1.03, p=0.11)). In countries that had negligible virtual care prepandemic, the proportion of visits that were virtual were highest in Canada (77.0%) and Australia (41.8%). In Norway (RR 8.23 (95% CI 5.30 to 12.78, p<0.001), the UK (RR 2.36 (95% CI 2.24 to 2.50, p<0.001)) and Sweden (RR 1.33 (95% CI 1.17 to 1.50, p<0.001)) where virtual visits existed prepandemic, it increased significantly during the pandemic.ConclusionsThe drop in primary care in-person visits during the pandemic was a global phenomenon across INTRePID countries. In several countries, primary care shifted to virtual visits mitigating the drop in in-person visits.

Depression amongst physicians can lead to poor individual and institutional outcomes. This study examined the prevalence and factors associated with depression and suicidal ideation amongst doctors in Hong Kong. Doctors who graduated from medical school at the University of Hong Kong between 1995 and 2014 were invited to participate in a survey measuring depressive symptoms, suicidal ideation and thoughts of self-harm, lifestyle behaviours, career satisfaction and socio-demographic characteristics. Data collection occurred between January and April 2016. The prevalence of screened-positive depression was 16.0% and 15.3% of respondents reported having suicidal ideation. Amongst those with positive depression screening scores, less than half reported having a diagnosed mood disorder. Sleeping fewer hours was associated with higher depression scores (P < 0.001) and an increased odds of meeting the cut-off for depression (P < 0.001). Factors associated with suicidal ideation included being unmarried (P = 0.012) and sleeping fewer hours (P = 0.022). Hong Kong doctors appear to have high rates of undiagnosed depression, and high levels of depressive symptoms and suicidal ideations. There is a need for greater awareness of the morbidity due to depression and to promote better mental health help-seeking among physicians. Barriers to mental health help-seeking need to be addressed and appropriate resources allocated to reduce suffering.

Purpose The aim was to evaluate knowledge, attitudes, and clinical practice concerning medical genetics, genetic testing, and counseling among primary care physicians (PCPs) in Hong Kong and Shenzhen, China. Methods The University of Hong Kong (HKU), HKU‐Shenzhen Hospital, and Shenzhen Health Capacity Building and Continuing Education Center invited PCPs from Hong Kong and Shenzhen to participate in an online survey. Results The survey was completed by 151 PCPs and 258 PCPs from Hong Kong and Shenzhen, respectively. The majority agreed it was important to keep current with genetics (91%) and that personalized medicine was the future of healthcare (86%), yet only 10% reported that they had postgraduate training in genomic medicine. Seventeen percent of Hong Kong and 40% of Shenzhen's PCPs encountered genetic‐related cases in the past 6 months, and they identified insufficient knowledge, few training opportunities, and self‐rated low confidence in their skillsets as main barriers. Conclusions Our survey shows that Hong Kong and Shenzhen's PCPs are not yet fully utilizing potential benefits of genomic medicine in their clinical practice, which could be addressed with a combination of easily accessible educational resources, clear referral pathways and guidelines on genetic diseases, and cross‐specialty collaboration between healthcare systems and professional bodies.

Purpose: To determine whether enablement was a moderator of the effect of chronic back and knee pain on health-related quality of life (HRQOL). Methods: This was a cross-sectional study of 1319 Chinese primary care patients with chronic back and knee problems who completed the Chinese Patient Enablement Instrument-2 (PEI-2), the Chinese Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the Pain Rating Scale (PRS). Multivariable regression examined the effect of disease characteristics, PRS score and PEI-2 score on WOMAC total score. Moderation was evaluated by whether the interaction between enablement (PEI-2 score) and pain (PRS score) had a significant effect on HRQOL (WOMAC total score) in the moderation regression model and by simple slope analysis. Results: Valid data from 1306 participants were analyzed. PRS score was associated with WOMAC total score (β = 0.326, p<0.001), while PEI-2 score was associated inversely (β = -0.260, p<0.001). There was an inverse relationship between PRS and PEI-2 scores. The effect of the interaction between PRS and PEI-2 (PRS*PEI-2) scores on the WOMAC total score was significant (β = -0.191, p<0.001) suggesting PEI-2 was a moderator. Simple slope analyses showed the relationship between PRS and WOMAC was stronger for participants with a low level of PEI-2 (gradient=3.056) than for those with a high level of PEI-2 (gradient =1.746) Conclusions: Patient enablement moderated the impact of pain on HRQOL. A higher level of enablement can lessen impairment in HRQOL associated with chronic back and knee pain.

Objectives To highlight the prevalence of sleep problems and identify associated risk factors among a representative sample recruited from the general population of Hong Kong. Design, setting and participants Participants included 12 022 individuals (aged 15 or above) who took part in the Population Health Survey 2014/15, a territory-wide survey conducted by the Department of Health of the Government of the Hong Kong Special Administrative Region. Primary and secondary outcome measures Outcomes were the prevalence of (1) insufficient sleep (<6 hours sleep per day) and (2) any sleep disturbance (difficulty initiating sleep, intermittent awakenings, early awakening) ≥3 times per week in the past 30 days. Multivariable logistic regression identified associations between sleep problems and sociodemographic, clinical and lifestyle factors. Results 9.7% of respondents reported insufficient sleep and 10.5% reported sleep disturbances ≥3 times a week. Female gender, monthly household income <$12 250 (Hong Kong dollar), lower education level, mental health condition and physical health condition were significantly associated with both insufficient and disturbed sleep (all p<0.05). Unemployment, homemaker, insufficient physical activity, current/former smoking status and harmful alcohol consumption were associated with sleep disturbances only (all p<0.01). Conclusions Sleep problems are highly prevalent in Hong Kong. As such problems are associated with a range of health conditions, it is important to facilitate improvements in sleep. Our results show that harmful alcohol consumption, insufficient physical activity and current smoking are modifiable risk factors for sleep disturbances. Public health campaigns should focus on these risk factors in order to promote a healthy lifestyle and ultimately reduce sleep disturbances. Targeted interventions for high-risk groups may also be warranted, particularly for those with doctor-diagnosed physical and mental health conditions.

Health empowerment can be an effective way to reduce health inequities. This prospective cohort study evaluated the 5 year impact of a health empowerment program (HEP) on health outcomes among adults from low-income families. The Patient Enablement Instrument version 2 (PEI-2), Depression, Anxiety and Stress Scale 21 (DASS-21), and 12 item Short-Form Health Survey version 2 (SF-12v2) were administered at baseline and follow-up for both intervention and comparison groups. A total of 289 participants (n = 162 for intervention group, n = 127 for comparison group) were included in the analysis. Most of the participants were female (72.32%), and aged from 26 to 66 years old (M = 41.63, SD = 6.91). Linear regressions weighted by inverse probability weighting using the propensity score showed that, after follow-up of 5 years, the intervention group demonstrated significantly greater increases in all items and total scores for the PEI-2 (all B > 0.59, p < 0.001), greater decreases in the DASS depression score (B = −1.98 p = 0.001), and greater increases in the Mental Component Summary score of the SF-12v2 (B = 2.99, p = 0.027) than the comparison group. The HEP may be an effective intervention enabling adults from low-income families to manage their health-related issues and improve their mental health, as evidenced by our study.

Background Information on HRQOL can enhance patient diagnosis and management but it is rarely available in routine clinical practice. This mixed-method study evaluated the feasibility and acceptability of the electronic EQ-5D-5L measurement of HRQOL in patients with chronic musculoskeletal problems in primary care. Methods In three primary care clinics, 665 patients with musculoskeletal problems completed the electronic EQ-5D-5L and Visual Analogue Scale (e-EQ-5D-5L/VAS), and a questionnaire on socio-demographics, perceived ease of use (PEOU), and perceived usefulness (PU) at baseline and two follow-ups. Patient completion and response rates, and time to complete the e-EQ-5D-5L/VAS were measured. During the same consultations, 49 doctors reviewed the e-EQ-5D-5L/VAS reports and completed a clinician questionnaire on PEOU, PU, and time spent to address each report. Individual interviews along with focus group discussions were conducted on patients, doctors, and research assistants for further exploration. Results Mean completion time reduced from baseline to first and second follow-up (120.66, 83.99, and 105.22 s, respectively). Completion and response rates were high at each follow-up visit (> 99.8% and > 91.11%, respectively). Doctors needed less than 2 min to read the report but felt the time required to address the report was a significant barrier. Some patients had difficulties using e-platforms, in understanding or answering questions; but, PEOU improved with time (p < 0.001). Most patients found the e-platforms useful (> 85.3%). Clinicians agreed a great majority of the reports were easy to use (76.0–85.1%) and useful (69.2–72.0%), particularly aiding with a holistic view of the patient's musculoskeletal problem. Conclusion The e-EQ-5D-5L/VAS is a feasible and acceptable measurement of HRQOL of patients with chronic musculoskeletal problems in routine primary care in Hong Kong which can assist real-time management decisions. Trial registration: NCT03609762.